| NPI | 1679163737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINTON COOPER Owner 336-963-9885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2021-01-22 |