| NPI | 1912214198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY THEIS President 703-938-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810003318) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2010-09-08 |