| NPI | 1134745805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE L. JACKSON CEO 757-768-6878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2020-06-18 |