| NPI | 1124883434 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | STACIE ANITA PITTMAN Pmhnp Bc 757-531-6485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-02-15 |