| NPI | 1053403386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE LEE BRYANT Director 571-594-9622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 02802) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2014-12-05 |