| NPI | 1922567874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA WALLACE BOGGESS Np 704-737-9643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2019-03-19 |