| NPI | 1891712758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEMBERLY LILES Clinical Services Director 804-279-9468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 463) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2008-09-16 |