| NPI | 1588984348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARISSE JOHNSON Executive Director 704-258-1622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 101YM0800X Counselor Mental Health | |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2021-01-27 |