| NPI | 1548022601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY DECHELLE WIGGINS Director 336-314-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-01-24 |