| NPI | 1164880993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVA CARTER KERSHAW Clinical Supervisor 804-539-3117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904006909) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-02-08 |