| NPI | 1053726398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY GILPIN Administrative Officer 804-616-6923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2073-03-001) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |