| N/a | |
|
1104 Aprilia Ln Dallas NC 28034-9382 | |
| (704) 923-8005 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1104 Aprilia Ln, Dallas, North Carolina |
| Authorized Official Name and Position | John Wesley Thomas (CEO/PRESIDENT) |
| Authorized Official Contact | 7049238005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 1104 Aprilia Ln Dallas NC 28034-9382 Ph: (704) 923-8005 | N/a 1104 Aprilia Ln Dallas NC 28034-9382 Ph: (704) 923-8005 |
| NPI Number | 1699119149 |
|---|---|
| Provider Enumeration Date | 04/25/2013 |
| Last Update Date | 04/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699119149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CSAC 1911 (North Carolina) | Primary |
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