| NPI | 1326558297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH FORMAN Licensed Clinical Psychologist 804-554-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: VA 0810005256) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2017-10-05 |