| NPI | 1679116636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M FORSE Owner/Provider 757-603-3997 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 305S00000X Point of Service |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-10-23 |