| NPI | 1104588375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JACKSON CEO 434-229-0172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-06 |