| NPI | 1962861641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN LAMONT MINTER Owner 804-306-0163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1152) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |