| NPI | 1649506957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON A TOWNSEND Billing Accounts Manager 910-580-2898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |