| NPI | 1720517923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIS O. HENDERSON Owner 804-852-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 0904006909) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2018-06-20 |