| NPI | 1962538694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FONDA CLARK Administrator 910-234-0655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC mhl024-058) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |