| NPI | 1689925489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN COOK MAYTORENA Owner 703-519-6770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810000296) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |