| NPI | 1710418462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIKI SHEREE LOGAN CEO 704-466-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |