| NPI | 1003903634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE B JACOBE Member 276-679-0162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904003054) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-07-21 |