| NPI | 1912938200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN WHITESIDE Supervisor 804-545-5951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0904005775) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-22 |