| NPI | 1841862299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUANITA HENDERSON Owner 704-548-0567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |