| NPI | 1891578589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD FULTON Owner 757-337-9275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-08-16 |