| NPI | 1811436330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY KAGAN Licensed Professional Counselor 757-650-9623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CO 12667) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |