| NPI | 1609390046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH EDWARD NISSEN Owner/Therapist 704-900-2904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NC c) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-08-07 |