| NPI | 1497126122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALARIE DOUGLAS Administrator 336-856-8011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX h4183) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 207R00000X Internal Medicine (Licence: TX q228) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX q228) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX p3036) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX h4516) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX p3036) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 626781) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-22 |