| NPI | 1679194476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT CHARLES THOMPSON Owner 910-644-3597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2020-05-03 |