| NPI | 1447700638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRA J MOORE Clinical Director 571-247-8039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 14343) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |