| NPI | 1649005653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNTE MARIE PARKS Member/Manager 757-672-4482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2026-06-04 |