| NPI | 1699488247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LANGE Owner 757-598-1692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2023-02-06 |