| NPI | 1659151660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEY MNANING Executive Director 757-630-1493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |