| NPI | 1427838697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAZIE L. ELLIS Licensed Clinical Social Worker 910-391-4520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-30 |