| NPI | 1235322231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY N E SULLIVAN Executive Director 757-224-5091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 163WP0808X Registered Nurse Psychiatric/Mental Health | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |