| NPI | 1730566001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY E MASON President 757-434-1828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2015-05-06 |