| NPI | 1235636069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY BURCH Office Manager 757-873-1958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-04-09 |