| NPI | 1275502106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDDIE DEAN VINES President 757-873-2307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002078) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-22 |