| NPI | 1770926503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LYNN GRIFFIN Owner 240-707-0399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC C010516) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MD 16635) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2017-01-06 |