| NPI | 1689397523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUATYSHA NIA JACKSON Owner 804-822-0236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-05-08 |