| NPI | 1689189318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES INGRAM Own Er 804-475-0099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: VA 094010031) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: VA 0904010031) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |