| Building Lives In Unison, Inc | |
|
2121b Keller Ave Norfolk VA 23504-3106 | |
| (757) 679-2583 | |
| Not Available |
| Full Name | Building Lives In Unison, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 2121b Keller Ave, Norfolk, Virginia |
| Authorized Official Name and Position | Phillip Maurice Riddick (PRESIDENT) |
| Authorized Official Contact | 7576792583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Building Lives In Unison, Inc 2655 Tidewater Dr Unit 7644 Norfolk VA 23509-1294 Ph: () - | Building Lives In Unison, Inc 2121b Keller Ave Norfolk VA 23504-3106 Ph: (757) 679-2583 |
| NPI Number | 1831721166 |
|---|---|
| Provider Enumeration Date | 02/05/2020 |
| Last Update Date | 02/05/2020 |
| Certification Date | 02/05/2020 |
| Medicare PECOS PAC ID | 0840601191 |
|---|---|
| Medicare Enrollment ID | O20201118001025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831721166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Phillip Riddick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801272208 PECOS PAC ID: 3173811601 Enrollment ID: I20161014001925 |
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