| NPI | 1982494837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON COULSON Owner 757-239-5858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-05-13 |