| NPI | 1366565954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNESSA GLASS Director 757-717-0605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002709) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000634) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-09-30 |