| NPI | 1013498757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MASTERSON Owner 757-237-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: VA 0904006823) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2024-04-23 |