| NPI | 1508117631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETSIE GENERETTE Qualified Professional 910-323-0584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 026931) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |