| NPI | 1568999050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP KECK Director And CEO 804-640-6848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005353) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2022-07-21 |