| NPI | 1841352101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT BEAVERS Credentialing Manager 919-210-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2021-09-20 |