| NPI | 1437474244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LE Supervisor/Owner 704-895-3415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 102875 (provisional)) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NC 102875 (provisional)) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |