| NPI | 1053605766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISON ANNE SULLIVAN Owner 540-907-0991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904007615) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2011-05-31 |