| NPI | 1366232639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON KELLEY Owner 757-713-9883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-05-09 |