| NPI | 1518379072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KINLEE DEATRICEE STEWART Owner 757-472-5143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2115) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2014-06-02 |