| NPI | 1265835219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH K. EWELL Licensed Clinical Psychologist 703-322-0701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: VA 0810002479) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |