| NPI | 1336510254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOU PHILLIPS Administrator 757-651-3003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004521) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009182) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2023-07-14 |