| NPI | 1235476490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY SAMUEL GOODMAN Licensed Clinical Psychologist 757-397-4394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2013-01-08 |