MEDICARE: SEVEN SUMMITS FAMILY SERVICES, 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	251S00000X	Community/Behavioral Health Agency	2474	VA

General Provider Information

NPI Number	:	1942672290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVEN SUMMITS FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	3634 S PLAZA TRL
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3351
Country	:	US
Telephone Number	:	757-725-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	3634 S PLAZA TRL
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3351
Country	:	US
Telephone Number	:	757-725-2728
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KWAME LEE
Credential	:
Telephone Number	:	757-725-2728

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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