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3217 Portsmouth Blvd Portsmouth VA 23701-3021 | |
| (757) 324-9963 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3217 Portsmouth Blvd, Portsmouth, Virginia |
| Authorized Official Name and Position | Lateefah Robinson (DIRECTOR) |
| Authorized Official Contact | 7573249963 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2546 Virginia Beach VA 23450-2546 Ph: (757) 340-3489 | 3217 Portsmouth Blvd Portsmouth VA 23701-3021 Ph: (757) 324-9963 |
| NPI Number | 1205467016 |
|---|---|
| Provider Enumeration Date | 01/30/2020 |
| Last Update Date | 06/10/2021 |
| Certification Date | 06/10/2021 |
| Medicare PECOS PAC ID | 4082148044 |
|---|---|
| Medicare Enrollment ID | O20241113001899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205467016 | NPI | - | NPPES |
| Provider Name | Cathy Manier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376072728 PECOS PAC ID: 1254866882 Enrollment ID: I20241120000053 |
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