| NPI | 1477506343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT K MATLACK Owner 910-323-1543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: NC 200201282) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 4894) |
| 101YP2500X Counselor Professional (Licence: NC 3566) | |
| 101YP2500X Counselor Professional (Licence: NC 4616) | |
| 103TC0700X Psychologist Clinical (Licence: NC 2775) | |
| 103TC0700X Psychologist Clinical (Licence: NC 3148) | |
| 1041C0700X Social Worker Clinical (Licence: NC C000342) | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-02-08 |