| NPI | 1912356247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALANDA Y JACKSON Owner 804-665-3147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904009104) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-06-07 |