| NPI | 1689122012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRIE LYNNE BOGAZ Owner 804-437-2599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006987) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |