| NPI | 1962517144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS A DEREPENTIGNY Owner 910-864-7004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL-047-096) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2008-10-01 |