| NPI | 1720749203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BOLT Owner/Clinician 704-579-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2024-06-20 |