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NPI Code Detail

MEDICARE: SHACORI HILL QMHP -A/C

MEDICARE: SHACORI HILL QMHP -A/C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor2007VA
2171M00000XCase Manager/Care Coordinator0732005844VA

General Provider Information

NPI Number : 1245075845
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHACORI HILL QMHP -A/C
Provider Business Mailing Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-861-9020
Fax Number :
Provider Business Practice Location Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-861-9020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2024
Last Update Date : 06/26/2024

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Directions to “ SHACORI HILL QMHP -A/C” Practice Location

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