| NPI | 1356745673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM TRAVIS JORDAN President 757-374-7297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004861) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2022-07-21 |