| NPI | 1669711701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MARIE PENWELL Owner 919-319-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 8358) |
| Enumeration Date | 2013-02-09 |
| Last Update Date | 2021-03-25 |