| NPI | 1508677113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL LAMONT JOHNSON Owner 804-339-5381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2025-01-15 |