| NPI | 1790219871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL NDUPU Clinical Director, Owner 980-224-8060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251X00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4936) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2023-06-19 |