| NPI | 1639052947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAETLIN GREER RITCHIE-KOSE Member Manager 540-850-6728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-07-26 |
| Last Update Date | 2025-07-26 |