| NPI | 1487250965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE TABRON Owner 704-960-6180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2023-05-10 |