| NPI | 1053298059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN ELLISON Owner 804-338-0990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-08-20 |