Healthcare Provider Details

I. General information

NPI: 1619839248
Provider Name (Legal Business Name): YOLANDA YVETTE WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 FOREHAND DR
CHESAPEAKE VA
23323-2006
US

IV. Provider business mailing address

1065 GREEN ST
NORFOLK VA
23513-3374
US

V. Phone/Fax

Practice location:
  • Phone: 757-861-9020
  • Fax:
Mailing address:
  • Phone: 757-676-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0735001447
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: