Organization
CONSUETUDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE AZAAN (CEO)
(646) 450-1448
Entity
Organization
Contact information
Practice address
226 NEW BRIDGE ST, JACKSONVILLE, NC 28540-4737
(646) 450-1448
Mailing address
PO BOX 92, JACKSONVILLE, NC 28541-0092
(646) 450-1448
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/19/2013
Last updated
02/19/2013
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