| NPI | 1679064570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND EDWARD LONEY CEO 804-308-3948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-05-25 |