| NPI | 1578167201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATYANA KHOLODKOV Owner 919-355-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |