| NPI | 1194014878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFNEY LEQUITA WARD HAIRSTON Program Director 804-283-1422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1454) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-04-01 |