| NPI | 1578795274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMEO NICOLE NICHOLS Admininstor 704-904-8532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9601323) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2012-01-13 |