| NPI | 1962519165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J THOMAS STACK President 910-347-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NC 0321) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-08-22 |