| NPI | 1326575192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA MEAD Reimbursement/Contract Manager 704-865-3529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-07-21 |