| NPI | 1417370818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE S BOWERSOX Office Administrator 704-202-2056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 251S00000X (Licence: NC 4413) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist (Licence: NC 4413) | |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2017-08-17 |