| NPI | 1699516963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FEDENA WADE Member 804-930-4720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |