| NPI | 1477910511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUKIEA KAKOUCHE Owner 757-985-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2477) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2025-02-18 |