| NPI | 1639530629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEVEN GARDNER Member 703-341-5995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 904005796) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 080003355) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-03-17 |