| NPI | 1790096808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA DANIELLE PAYNE Billing Assistant 804-225-9144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 360) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2010-06-24 |