| NPI | 1649455767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALONZO MASON Finance Supervisor 910-735-0556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |