| NPI | 1083791511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LANE Director, Accounts Receivable 540-542-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA Several) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA Several) |
| 101Y00000X Counselor (Licence: VA Several) | |
| 103G00000X Clinical Neuropsychologist (Licence: VA Several) | |
| 103T00000X Psychologist (Licence: VA Several) | |
| 103TC0700X Psychologist, Clinical (Licence: VA Several) | |
| 104100000X Social Worker (Licence: VA Several) | |
| 1041C0700X Social Worker, Clinical (Licence: VA Several) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA Several) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-10-19 |