| NPI | 1215128467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINICA M DAVIS Office Manager 757-456-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904006406) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2012-05-09 |