| NPI | 1982724613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LOCKLEAR BULLARD Owner 910-997-2620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-07-17 |