| NPI | 1558015305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAVAH ISABEL HENZLER Owner 910-599-4017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1000X Clinic/Center, Migrant Health | |
| 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-10 |