| NPI | 1285351130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE TANYA DOUGLAS Owner 757-359-8144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2025-11-05 |