| NPI | 1952771438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIJUANA L FAULKS President 336-457-9313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-A22598) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC LPC-A12166) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2016-04-11 |