| NPI | 1649938598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN SCOTT RADOSEVICH Owner 252-777-2016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2022-11-30 |