| NPI | 1356668156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SUTHERLAND CEO/Founder 703-339-0106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 1042266) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 1042266) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 1042266) | |
| 103TF0000X Psychologist, Family (Licence: VA 1042266) | |
| 251B00000X Case Management (Licence: VA 1042266) | |
| 251S00000X Community/Behavioral Health (Licence: VA 1042266) | |
| 302F00000X Exclusive Provider Organization (Licence: VA 1042266) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2011-10-07 |