| NPI | 1336914191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAELER BRAINE MCCOLLOUGH Program Director 804-201-8060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2023-11-21 |