| NPI | 1366158545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUENA MCIVER Owner 336-944-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-10-19 |