| NPI | 1962548115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA SYDNEY Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2011-11-11 |