| NPI | 1336699461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE R MATTINGLY Owner 804-442-3116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904007756) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2020-11-30 |