MEDICARE: GIFTED ENTERPRISES LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417501230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	22 RESEARCH DR STE 101A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1787
Country	:	US
Telephone Number	:	757-358-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 RESEARCH DR STE 101A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1787
Country	:	US
Telephone Number	:	757-358-3677
Fax Number	:

Authorized Official
Title or Position	:	COO/PRESIDENT/CO FOUNDER
Name	:	MS. ONICKA JOVAN DANIEL
Credential	:	QMHP-A
Telephone Number	:	757-358-3677

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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Directions to “GIFTED ENTERPRISES LLC ” Practice Location

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