| NPI | 1982367801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIDA FALTZ CEO 757-239-9125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2024-02-07 |