| NPI | 1659801934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL TEAGLE Sole Proprietor 757-298-4963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0701004462) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2017-06-19 |