| NPI | 1194325191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MCINTOSH Lpc 757-320-9331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |