Robert T Lee Foundation Llc | |
610 Thimble Shoals Blvd # 403 Newport News VA 23606-2573 | |
(901) 672-2228 | |
Not Available |
Full Name | Robert T Lee Foundation Llc |
---|---|
Speciality | Social Worker |
Location | 610 Thimble Shoals Blvd # 403, Newport News, Virginia |
Authorized Official Name and Position | Jarvis Donnell Lee (CEO) |
Authorized Official Contact | 9016722228 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Robert T Lee Foundation Llc 31 Harwood Ave Hampton VA 23664-1044 Ph: (901) 672-2228 | Robert T Lee Foundation Llc 610 Thimble Shoals Blvd # 403 Newport News VA 23606-2573 Ph: (901) 672-2228 |
NPI Number | 1982360079 |
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Provider Enumeration Date | 11/12/2021 |
Last Update Date | 04/09/2022 |
Certification Date | 04/09/2022 |
Medicare PECOS PAC ID | 5092106534 |
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Medicare Enrollment ID | O20211217000322 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982360079 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Jarvis Donnell Lee |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1740765437 PECOS PAC ID: 8527459064 Enrollment ID: I20211217000427 |
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