| NPI | 1790389484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHMAD BLAKENEY Owner 704-201-8038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LC1500X Nurse Practitioner, Community Health | |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2020-11-24 |