| NPI | 1619105988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODUS ROACH Executive Director 704-604-1437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3676) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005215) |
| 1041C0700X Social Worker, Clinical (Licence: NC C006053) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C005319) | |
| 1041C0700X Social Worker, Clinical (Licence: NC P002725) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2009-06-25 |