| NPI | 1508249400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN E TIRELLA Owner/Director 571-882-1879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0133000432) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |