| NPI | 1710743521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONDESHYA KEYONNA COSBY Owner 252-751-5103 |
| 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 | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |