| NPI | 1336417419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICE ANTONIO CANNON CEO 757-892-0467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1334) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2011-12-05 |