| NPI | 1396149829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN ERIC SMITH Owner 757-412-7753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0717001246) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2014-10-13 |