| NPI | 1790254308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANTONIO HOWELL President 336-456-8357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2022-04-11 |