| NPI | 1760853410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE ELLEN Owner/Provider 910-754-7377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10093) |
| Additional Taxonomies | 251S00000X (Licence: NC LPC 10093) |
| 251S00000X (Licence: NC LCAS 3399) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2016-06-01 |