| NPI | 1518431097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHA SIMMONS Director 704-390-4241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |