| Innervation,llc | |
|
3100 London Blvd Suite 2 Portsmouth VA 23707-3402 | |
| (757) 673-4430 | |
| (757) 673-4432 |
| Full Name | Innervation,llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3100 London Blvd, Portsmouth, Virginia |
| Authorized Official Name and Position | Vonda R Alston (PRESIDENT/CEO) |
| Authorized Official Contact | 7576734430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innervation,llc 3100 London Blvd Suite 2 Portsmouth VA 23707-3402 Ph: (757) 673-4430 | Innervation,llc 3100 London Blvd Suite 2 Portsmouth VA 23707-3402 Ph: (757) 673-4430 |
| NPI Number | 1588962930 |
|---|---|
| Provider Enumeration Date | 03/09/2011 |
| Last Update Date | 03/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588962930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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