| NPI | 1891191805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MAZZIO Clinical Psychologist 757-319-4650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004778) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005945) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |