| NPI | 1083312573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN JACKSON Member/Owner 804-501-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-05-01 |