| NPI | 1285009712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRANTLEY Practice Manager 919-316-9286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 0560) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NC 0560) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2016-01-27 |