| NPI | 1285227884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERROD ANTHONY KOON Licensed Clinical Psychologist 540-208-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2023-02-04 |