| NPI | 1124133327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY W. JEFFERSON Owner/President 434-385-0744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001866) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-07-31 |