| NPI | 1801413687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD FLACK Owner 336-587-2931 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2020-06-29 |