| NPI | 1811057045 |
|---|---|
| Doing Business As | CHANGING PHASES BEHAVIORAL SUPPORT ONE |
| Entity Type | Organization |
| Authorized Contact | QUINTEN CULLINS Program Director 336-333-2542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-041-794) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-041-894) |
| 251S00000X | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-03-12 |