| NPI | 1194954008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDI JACKSON President 804-378-7710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 829-05-001) |
| Additional Taxonomies | 251S00000X (Licence: VA 829-05-001) |
| 101Y00000X Counselor (Licence: VA 829) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2011-04-08 |