| NPI | 1639840341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON FLACK Owner 336-587-2931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-28 |