| NPI | 1346772712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA MARTIN Chief Executive Officer 571-288-3314 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |