| NPI | 1164114559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON SAMPEDRO Director 703-389-2832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QM0801X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-05-23 |