| NPI | 1356855670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY BOSTIC Practice Manager 704-948-1268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 3949) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2026-04-08 |