| NPI | 1215143789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ELLIS MONTGOMERY President 804-288-8823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810000730) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |