| NPI | 1366698508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GIBBS Administrator 704-942-8410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 3499) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 3698) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3499) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3698) | |
| 101YM0800X Counselor, Mental Health (Licence: NC 3698) | |
| 101YP2500X Counselor, Professional (Licence: NC 3499) | |
| 101YP2500X Counselor, Professional (Licence: NC 3698) | |
| 102L00000X Psychoanalyst (Licence: NC 3499) | |
| 103T00000X Psychologist (Licence: NC 3499) | |
| 103T00000X Psychologist (Licence: NC 3698) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 3499) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 3698) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2012-12-03 |