| NPI | 1730469925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD S JACOBSON Owner 757-213-6995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810000305) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2011-08-19 |