| NPI | 1104120294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN CARSON BLACKWOOD Licensed Clinical Psychologist 434-315-8813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001049) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701003954) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2011-01-04 |