| NPI | 1710614680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA TAYLOR WIGGINS Credentialing Manager 704-498-7736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-01-04 |