| NPI | 1639687312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALIA BRYAN Therapist/ Lcsw 757-358-1771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 0904008852) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: VA 0904008852) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2018-01-17 |