| NPI | 1316947328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY ALEXANDRA KEDROCK President 757-640-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904000234) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 4274) |
| 103TC0700X Psychologist, Clinical (Licence: VA 4274) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 4274) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2020-08-22 |