| NPI | 1639508559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERWIN L HICKMAN CEO 804-271-7263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 792-04-001) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2013-11-01 |