| NPI | 1427666106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY NICKENS Owner 804-677-0223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-17 |