| Fly Family Therapy, Inc. | |
|
718 J Clyde Morris Blvd Ste D Newport News VA 23601-1540 | |
| (757) 873-8566 | |
| (757) 595-1885 |
| Full Name | Fly Family Therapy, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 718 J Clyde Morris Blvd Ste D, Newport News, Virginia |
| Authorized Official Name and Position | Kristen L. Fly (CLINICIAN, SUPERVISOR) |
| Authorized Official Contact | 7579125359 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fly Family Therapy, Inc. 718 J Clyde Morris Blvd Ste D Newport News VA 23601-1540 Ph: (757) 873-8566 | Fly Family Therapy, Inc. 718 J Clyde Morris Blvd Ste D Newport News VA 23601-1540 Ph: (757) 873-8566 |
| NPI Number | 1881171668 |
|---|---|
| Provider Enumeration Date | 07/24/2018 |
| Last Update Date | 07/24/2018 |
| Medicare PECOS PAC ID | 7315377173 |
|---|---|
| Medicare Enrollment ID | O20200417001638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881171668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Virginia) | Primary |
| Provider Name | David Richard Fly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720558075 PECOS PAC ID: 6103256961 Enrollment ID: I20200423000258 |
| Provider Name | Francis L Fly |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1225114549 PECOS PAC ID: 4385074145 Enrollment ID: I20240110004918 |
| Provider Name | Jennifer Dattilo Watts |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124669858 PECOS PAC ID: 0648618975 Enrollment ID: I20240405002172 |
| Provider Name | Maria K Weaver |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164678330 PECOS PAC ID: 8022459031 Enrollment ID: I20240508002097 |
| Provider Name | Kristen Fly |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1548395478 PECOS PAC ID: 7911337779 Enrollment ID: I20240603002077 |
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