| NPI | 1619186970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL092633) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL092247) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL092631) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-07-02 |