| NPI | 1861643876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FONDA D CLARK Administrator 910-642-6915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 251S00000X) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |