| NPI | 1679195895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM TRAVIS CROCKER Owner 804-356-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |