| NPI | 1477819712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA GORDON WALTMAN Owner/Operator 336-288-9190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional (Licence: NC 7308) | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-11-11 |