| NPI | 1396286019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KLEWICKI Clinical Psychologist 571-277-4919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810002980) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |