| NPI | 1750223194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RE'QUAVAS JACQUI WRAY Lcmhc A 704-466-9257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2026-04-06 |
| Last Update Date | 2026-04-06 |