| NPI | 1861980260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YAISA GOODWIN Credentialing Consultant 757-339-8798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904009647) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-05-01 |