| NPI | 1912186735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEQUA CORNISE BENTON Member/Organizer 252-475-9829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: NC 261qr0400x) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NC 261qm0855x) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: NC 261qm0850x) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-11-01 |