| NPI | 1750610465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA M. PHIPPS Clinical Director 4345-949-6954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002630) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004698) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2010-04-08 |