| NPI | 1386445419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY KNOTTS Senior Credentialing Specialist 704-986-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |