| NPI | 1710503784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE EBORN TYNDALL Owner 252-402-0234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-11-03 |