| NPI | 1831942069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ANTWAN BANKS Owner 757-215-8105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-08 |