| NPI | 1295468742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WAGONER Lcmhc 910-520-4316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-06-20 |