| NPI | 1740586106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA SHADE Practice Manager 804-612-1947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 1726-07-010) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 261QA0600X Clinic/Center, Adult Day Care (Licence: VA 1726-02-010) | |
| 261QD1600X Clinic/Center, Developmental Disabilities (Licence: VA 1726-07-010) | |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2024-10-03 |