| NPI | 1124255468 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | CHARLENE HEARNE WENTLAND President 757-817-7125  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA PBS Provider 144)  | 
| Enumeration Date | 2009-06-13 | 
| Last Update Date | 2009-06-13 |