| NPI | 1790324184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE BLAIR POLITE Owner 336-816-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QC1500X Clinic/Center, Community Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |