| NPI | 1164596888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI VAN CLEAVE Clinical Psychologist Director 804-308-9133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 0830003638) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: VA 0810003638) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: VA 0810003638) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003638) | |
| 103TC0700X Psychologist, Clinical (Licence: MT 324) | |
| 103TC0700X Psychologist, Clinical (Licence: CO 2472) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |