| NPI | 1154847176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY THORPE ELLISON Owner 757-755-0263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008204) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2022-07-21 |