| NPI | 1588944151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MOORE Exec Officer 888-800-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: VA 1630) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2012-04-10 |