| NPI | 1649624164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA LARKIN Credentialing Specialist 434-200-5047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2016-04-21 |