| NPI | 1134776370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN RENEE RUSSELL Owner 804-505-2560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2024-03-24 |