| NPI | 1528804440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE DENISE KAZUBA Clinical Director 703-975-6351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2024-07-02 |