| NPI | 1699300160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATRINA BANKS Owner 757-309-0104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2020-03-05 |