| NPI | 1821654716 |
|---|---|
| Other Name | NOT APPLICABLE |
| Entity Type | Organization |
| Authorized Contact | MARK J MAUPIN Owner 757-303-6335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-05-15 |