| NPI | 1760998496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMALL TRIMAINE MINOR Program Manager 804-252-2704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 2040-05-001) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2026-03-05 |