| NPI | 1720161987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDA TRUESDELL Owner 704-842-6317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-02-22 |