| NPI | 1285960377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMAYA A. RUCKER Director 757-903-3284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004168) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2009-10-23 |