| NPI | 1740412071 |
|---|---|
| Doing Business As | 180 BOYS ADOLESCENT GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | MARVIN VAN ROANE President/CEO 804-349-6382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2009-08-20 |