| NPI | 1497419600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL GAYNELL DEPIETRO Owner 910-551-0835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2023-05-08 |