| NPI | 1699963736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY BAILEY CEO 757-966-1864 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA 122010) |
| Additional Taxonomies | 251S00000X (Licence: PA 122010) |
| 261Q00000X Clinic/Center (Licence: PA 122010) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: PA 122010) | |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2008-02-22 |