| NPI | 1558774422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY MOON Clinical Director 704-989-1031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 8466) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3337) |
| 101YM0800X Counselor, Mental Health (Licence: NC 8466) | |
| 207R00000X Internal Medicine (Licence: NC 39164) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 39164) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |