| NPI | 1356957864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEITRA LATRICE FANT Owner/Clinician 703-857-5354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2020-11-23 |