| NPI | 1376689117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA D. WALLACE Director 252-353-8003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-074-139) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-074-140) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2015-12-22 |