| NPI | 1417232802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA BOURDON Director 757-460-2057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004468) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |