| NPI | 1982277836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE R MCCONVILLE Treasurer 919-360-5177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-05-24 |