| NPI | 1316180565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHESTER MICHAEL MARTIN Administrator 910-323-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2022-12-08 |