| NPI | 1720484587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN REX MILLER President 757-340-1164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810000350) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |