| NPI | 1083806483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY R GRIMSLEY Office Manager 757-591-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002415) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2007-08-10 |