| NPI | 1861925364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA WALDRON CHILDRESS Owner 804-641-5176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0701005620) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |