| NPI | 1053671461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESEREE BOLERE Owner 804-926-5268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251B00000X Case Management | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-05-18 |