| NPI | 1528716099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD JOHNSON CAO 804-510-4920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2023-10-17 |