| NPI | 1730851015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN LAMONT TELFAIR Owner/Director 336-689-0374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2022-03-22 |