| NPI | 1881843647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES LEONARD RIVENBARK Director 980-254-5401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC LCAS 1243) |
| Additional Taxonomies | 251S00000X (Licence: NC LPC 5490) |
| 251S00000X (Licence: NC LMFT 965) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |