| NPI | 1457171563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY ANN KRUK-BORISOV Owner / Manager 757-589-3498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-15 |