| NPI | 1497482020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEE M FALLIN Owner 804-724-3287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-09-11 |