| NPI | 1013391564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAVIN CONNOR Sole Proprietor 434-249-0230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0701005444) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-15 |