| NPI | 1306144910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA MICHELLE QUAILES ELLIS Owner/ President 704-999-7378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 266) |
| Enumeration Date | 2011-03-05 |
| Last Update Date | 2011-03-05 |