| NPI | 1982178257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE DAVIS Owner/Operator 757-574-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-01-19 |
| Last Update Date | 2019-01-19 |