| NPI | 1104151125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ALAN PETRY Owner 804-320-7738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002340) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2013-04-22 |