| NPI | 1952064883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARISSA PREUDHOMME Bcba 336-978-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2021-10-18 |