| NPI | 1427412360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE W LANE Sole Member 910-692-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 1264) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |