| NPI | 1043572886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ERNEST WALLACE CEO 276-223-0234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 1758) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-06-07 |