| NPI | 1780974253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSH MARTIN Executive Director 704-865-3529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC MHL-036-292) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363A00000X Physician Assistant | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2015-12-30 |