| NPI | 1306691019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM KNOELLER Provider 910-547-8567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |