| NPI | 1780950592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA MARIE MARINO Director, CEO 571-257-3378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004487) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004539) |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2012-03-26 |