| NPI | 1104643220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW JECKLIN Owner 540-918-0118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-09-20 |