| NPI | 1629328083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY S POWELL Member 703-801-5527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904007483) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2016-01-28 |