| NPI | 1962720060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM TRAVIS CROCKER CEO 804-921-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 709-11) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |