| NPI | 1831941640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKLYN MICHELE BLAKE Credentialing Manager 919-889-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-04-04 |