| NPI | 1972491843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETITIA WALLACE Owner/Provider 804-635-6535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2025-06-27 |