| NPI | 1922467059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLETHA R MICKEN Quality Managment Director 336-210-3815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2016-02-17 |