| NPI | 1588055685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAWANDA BOSTIC Owner 704-322-4699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 196483) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 196483) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-03-30 |