| NPI | 1962748830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYSON JOHNSON Executive Director 757-644-4192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1807) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2012-12-21 |