| NPI | 1053005157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE ARNOLD Director Of Revenue Operations 540-907-2023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 103T00000X Psychologist |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-11-11 |