| NPI | 1477165926 |
|---|---|
| Doing Business As | WILDVINE THERAPY |
| Entity Type | Organization |
| Authorized Contact | ANNALUCIA BAYS Member 757-899-4804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2021-06-22 |