| NPI | 1700071891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M PORTNER Pschologist 757-461-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0810001188) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-09-11 |