| NPI | 1619682051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE DENISE LOGAN CEO 757-540-1488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 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 | 2023-01-19 |
| Last Update Date | 2023-11-08 |