| NPI | 1588265144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHMAD BLAKENEY Owner 704-201-8038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent | |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |