| NPI | 1649013418 |
|---|---|
| Other Name | XXX-XX-XXXX |
| Entity Type | Organization |
| Authorized Contact | JEFFREY CROSSON CEO 571-804-1808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-18 |