| NPI | 1902060585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY MONTGOMERY Business Manager 336-659-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 762) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2014-03-14 |