| NPI | 1487883385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL LAVAN ROGERS Owner 704-281-8416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 4666) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4666) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |