| NPI | 1689262891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY AINSWORTH IVESS Associate Director 571-366-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2021-01-04 |