| NPI | 1790018372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE JACKSON MELVIN Executive Director 757-438-5447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1264) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |