| NPI | 1952117657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE DALLAS DEGROAT Clinician 757-344-5265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2024-12-06 |