| NPI | 1669647913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE HOPE JACKSON Clinical Psychologist 251-470-7607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 1369) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |