| NPI | 1336975598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTIELOU GILLIAM CEO 757-608-1397 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-12 |