| NPI | 1861942237 |
|---|---|
| Doing Business As | PEGGY LIDSTROM LCSW |
| Entity Type | Organization |
| Authorized Contact | MARGARET RAY LIDSTROM Manager 757-636-9187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904000638) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-11-14 |