| NPI | 1679067995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTA LAVETTE JOHNSON Owner 984-209-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC C008341) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |