| NPI | 1184150781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA JACKSON Owner/Counselor 540-819-4353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0904009062) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2017-05-03 |