| NPI | 1831725456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN DAVIS Owner 804-318-0523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-03-15 |
| Last Update Date | 2024-07-12 |