| NPI | 1720429889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALCOLM ISAIAH MOODY Program Director 804-909-1762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2105) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-17 |