| NPI | 1407901689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R CLIFFORD PARKERS Ex Director 336-883-1361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2019-07-09 |