| NPI | 1508253923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WILLIAM WILEY Medical Director 919-850-9960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 21616) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21616) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NC 21616) | |
| 104100000X Social Worker (Licence: NC 21616) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 21616) | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2016-05-10 |