| NPI | 1790037976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS RAYMOND WOODSON Qp 336-317-9226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL-041-1056) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2012-10-11 |