| NPI | 1497122105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE MICHAEL ENNELS Social Worker 757-439-9026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904000980) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2015-08-28 |