| NPI | 1508136490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIUS CRAYTON CEO 704-956-3062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 1041C0700X Social Worker, Clinical | |
| 251S00000X | |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2012-01-11 |