| NPI | 1124994116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM RICHARDSON Credentialing 757-907-2567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2026-07-09 |