| NPI | 1336559764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA MCLEAN-GREEN Owner 704-215-4095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1828) |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2019-07-06 |