| NPI | 1265997407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL BEMISS GRAY Owner 336-276-1278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2022-04-04 |