| NPI | 1811289952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK KIRT STEVENS CEO/Owner 757-344-4406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904007351) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2011-05-09 |