| NPI | 1760891980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA DIXON Credentialing Specialist 910-520-6756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2025-08-04 |