| NPI | 1407221716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL RICHARD ELLIS Owner/CEO 757-640-1882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2019-08-15 |