| NPI | 1841322302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DINAH H NIEBURG Manager 434-977-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810002889) |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2018-06-21 |