| NPI | 1932614369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK CHRISTOPHER CARNEY Owner 251-635-4541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 1374) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 1129637) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2017-12-07 |