| NPI | 1639601461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL STUDIVANT NOWAK Licensed Clinical Psychologist 804-719-1955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005486) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2017-03-30 |