| NPI | 1659101749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISHA GOODRICH Owner 757-582-3722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-10-04 |