| NPI | 1285876458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE H JESSEE Counselor 276-676-2128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006739) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |