| NPI | 1043466394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN REX MILLER Owner / Partner 757-340-1164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810000350) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810000350) |
| 103TF0200X Psychologist, Forensic (Licence: VA 0810000350) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904005428) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2008-08-18 |