| NPI | 1811204217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY CLARK Administrator 919-785-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2023-02-23 |