| NPI | 1801379680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA WILDER Owner 984-212-3788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C010387) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-20491) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-07 |