| NPI | 1609427129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WIGGINS Owner 910-708-6025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2024-02-19 |