| Eastern Grove Support Llc | |
|
355 Crawford St Ste 600b Portsmouth VA 23704-2823 | |
| (833) 774-9633 | |
| Not Available |
| Full Name | Eastern Grove Support Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 355 Crawford St Ste 600b, Portsmouth, Virginia |
| Authorized Official Name and Position | Keenen Mapp (DIRECTOR) |
| Authorized Official Contact | 8337749633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Grove Support Llc 355 Crawford St Ste 600b Portsmouth VA 23704-2823 Ph: (757) 392-9337 | Eastern Grove Support Llc 355 Crawford St Ste 600b Portsmouth VA 23704-2823 Ph: (833) 774-9633 |
| NPI Number | 1700694320 |
|---|---|
| Provider Enumeration Date | 12/28/2024 |
| Last Update Date | 01/02/2025 |
| Certification Date | 01/02/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700694320 | NPI | - | NPPES |
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