| NPI | 1700060795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHACOBIAN LASHELLE THOMAS Director 336-509-0462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-041-854) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2007-12-26 |