| NPI | 1548885726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN R BENNETT Director 336-893-9018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 207Q00000X Family Medicine | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2020-06-12 |