| NPI | 1871075978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORENE P FICK Lcsw 540-597-8512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: VA 0904006769) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-05 |