| NPI | 1780004135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVIE L WIDEMAN COO 704-640-5501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC 29166) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 29166) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-04-28 |