| NPI | 1750643086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY FOZARD Officer 919-697-6957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-06-12 |