| NPI | 1194180653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH OWEN CLARK Therapist 757-814-8922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1551) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A10090) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2017-02-15 |