| NPI | 1083348395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENOHN CARTER Owner 757-593-1547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-07-12 |