| NPI | 1134727522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT CHRISTIAN PETERSON President 757-284-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2021-01-28 |