| NPI | 1700316304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER FAIRFAX Clinical Director 540-899-3199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004711) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701004711) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-21 |