| NPI | 1700651437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE L DAVIS Counselor 336-501-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2023-11-22 |