| NPI | 1295223535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNELL LUCAS CEO 336-545-5995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2020-12-16 |