| NPI | 1801568092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELORES JORDAN Owner 704-999-8627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-05 |