| NPI | 1952880502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE L DAVIS CEO/Executive Director 757-969-8584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 130655) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2024-10-07 |