| NPI | 1316825656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANESE D DANIELS Credentialing Specialist 910-860-7008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-08-25 |