| NPI | 1841652765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISSA BOWLES ALSTON Member 336-558-4479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-03-22 |