| NPI | 1508038001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLISSIE LAURA ANN PETERSON Director Of Operation 336-437-4382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QP2300X Clinic/Center Primary Care | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 363A00000X Physician Assistant | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2020-05-06 |