| NPI | 1063069185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE E. MIKKELSON Owner 434-258-0591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |