| NPI | 1417558958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRYSTAL G MOORE CEO/Administrator 757-323-9104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |