| NPI | 1316385438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN MICHELLE GRANTHAM Lpc A 919-394-1637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NC A10094) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |