| NPI | 1134820772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES WILSON Owner 757-215-6142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-03-10 |