| NPI | 1205096088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY LATOYA JOHNSON Director Of Administration 804-303-4587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 1104-05-001) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 1104) |
| Enumeration Date | 2008-06-14 |
| Last Update Date | 2009-10-19 |