| NPI | 1487952362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK RALEY Owner 704-566-3730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2011-03-02 |