| NPI | 1386378057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATLYN BROOKE TILLETT Managing Member 757-758-6001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2023-11-17 |