| NPI | 1336244201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP D DUPONT Manager 434-220-4686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701002481) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810001910) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810002135) | |
| 103T00000X Psychologist (Licence: VA 0810002867) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904003837) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904000547) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904006301) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101233438) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101047223) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |