| NPI | 1184190282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA LOUISE STANSBERY Licensed Clinical Professional 757-374-1849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |