| NPI | 1528428851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY DECHELLE WIGGINS Owner 336-314-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 175T00000X Peer Specialist | |
| 101YM0800X Counselor, Mental Health | |
| 253Z00000X In Home Supportive Care | |
| 385H00000X Respite Care | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 251S00000X Community/Behavioral Health | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 164W00000X Licensed Practical Nurse | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2025-10-13 |