| NPI | 1326814484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE VICTORINE Co Owner 571-534-3825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-12-20 |