| NPI | 1073650099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A VANLANDINGHAM Fiscal Administrator 757-547-9334 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: VA 141 16 001) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: VA 141) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2018-03-15 |