| NPI | 1619527645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFINEE YANCEY Clinical Specialist 757-717-9569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2024-03-14 |