| Na | |
|
11815 Fountain Way Ste 300 Newport News VA 23606-4448 | |
| (757) 606-9388 | |
| Not Available |
| Full Name | Na |
|---|---|
| Speciality | Clinic/Center |
| Location | 11815 Fountain Way Ste 300, Newport News, Virginia |
| Authorized Official Name and Position | Alafeya Bailey (CLINICIAN) |
| Authorized Official Contact | 7576069388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 11815 Fountain Way Ste 300 Newport News VA 23606-4448 Ph: (757) 606-9388 | Na 11815 Fountain Way Ste 300 Newport News VA 23606-4448 Ph: (757) 606-9388 |
| NPI Number | 1417578469 |
|---|---|
| Provider Enumeration Date | 04/30/2020 |
| Last Update Date | 08/27/2020 |
| Certification Date | 08/27/2020 |
| Medicare PECOS PAC ID | 5991126351 |
|---|---|
| Medicare Enrollment ID | O20200611000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417578469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Alafeya Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124651997 PECOS PAC ID: 6800217266 Enrollment ID: I20200611000251 |
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