| NPI | 1588876379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED SURGEON Director 910-733-0617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |