| NPI | 1669726766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE JOHNSON Provider 252-714-2369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL-054-167) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NC MHL-054-168) |
| 251S00000X Community/Behavioral Health (Licence: NC MHL-054-170) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-11-28 |