| NPI | 1811172026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TILMER O. ENGEBRETSON Owner 571-633-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003165) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810003165) |
| 103TH0004X Psychologist, Health (Licence: VA 0810003165) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2015-01-21 |