| NPI | 1477975779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS HERMAN WEBB Owner/Operator 704-712-6234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X (Licence: NC 0201069) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-07-22 |