| NPI | 1558558197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LYNETTE LEE Owner 252-426-7537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-12-31 |