| NPI | 1114416187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATIESHA WIGGINS Executive Director 757-394-4523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2018-05-06 |