| NPI | 1376725572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK BULLARD CEO 704-521-4977 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2007-11-29 |