| NPI | 1588106801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY GIENCKE Lpc 757-490-0377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0701006852) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2016-12-07 |