| NPI | 1114658465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN BOLLING Member/Practice Manager 757-268-1917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-17 |