| NPI | 1740517226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH EDWARD GREEN Program Executive Director 888-582-0224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5084) |
| 103T00000X Psychologist (Licence: NC 1581) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 1449) | |
| 251S00000X | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2011-05-24 |