| NPI | 1982732269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY BRADSHAW Office Manager 336-713-7188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2016-10-18 |