| NPI | 1760536460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA ROLLOCK Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2009-02-24 |