| NPI | 1750020954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUSHAN CAMPBELL Psychologist/Clinucal Director 571-255-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2022-06-03 |