| NPI | 1578949160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMBGRA JUANETTE BROADAWAY Clinical Director 704-578-7543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 8319) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2016-11-23 |