| NPI | 1265705461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIA C GLENN Administrator 757-864-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904003220) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904000953) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2021-11-04 |