| NPI | 1407457807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORCILLE M JERNIGAN Managing Owner 804-479-2862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |