| NPI | 1528477296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MICKENS President 804-387-0426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2063) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-08-07 |