| NPI | 1780127589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONA JUANITA PETERSON-OMOTOLA Pastor/Pastoral Counselor 866-720-5321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 14946) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |