| NPI | 1164669966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYNNE GALLARO Office Coordinator 540-437-4820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003002) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2009-01-15 |