| NPI | 1275679425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA M ROLLOCK Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-11-10 |