| NPI | 1699503227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERICK SONJONG President 571-277-0779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2024-07-24 |