| NPI | 1275339632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANEEN SHANELLE WHITE Program Operations Manager 757-709-5229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 405300000X Prevention Professional |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-24 |