| NPI | 1821742552 |
|---|---|
| Doing Business As | REBELLIOUS THERAPY |
| Entity Type | Organization |
| Authorized Contact | KATHERINE LEE ELIZABETH WALDRON CEO 704-290-9780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-03-15 |