Healthcare Provider Details

I. General information

NPI: 1366277634
Provider Name (Legal Business Name): DAREAN ESTORIA POLK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BATTLEFIELD BLVD S STE 200
CHESAPEAKE VA
23322-5233
US

IV. Provider business mailing address

303 S AMSTERDAM CT
VIRGINIA BEACH VA
23454-4264
US

V. Phone/Fax

Practice location:
  • Phone: 757-330-2439
  • Fax: 757-974-0041
Mailing address:
  • Phone: 757-724-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013851
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: