| NPI | 1538537519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT K MATLACK Owner 910-323-1543 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200201282) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A9626) |
| 103TC0700X Psychologist, Clinical (Licence: NC 3148) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C009047) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 144494) | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2021-02-08 |