| NPI | 1912512187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL COUNCIL Chief Executive Officer 757-238-1091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2020-09-14 |