| NPI | 1922213669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JELORE LITTLE Contract Administrator 336-545-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-07-12 |