| NPI | 1366167256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISHA MASSEY PRYOR Practice Manager 980-272-1908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |