| NPI | 1699215970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MICHAEL PORTNER Owner 757-642-2567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001188) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |