Healthcare Provider Details

I. General information

NPI: 1467081406
Provider Name (Legal Business Name): AIMIE BIRMINGHAM ED. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 LIBERTY ST
CHESAPEAKE VA
23324-3527
US

IV. Provider business mailing address

2107 LIBERTY ST
CHESAPEAKE VA
23324-3527
US

V. Phone/Fax

Practice location:
  • Phone: 209-988-3658
  • Fax:
Mailing address:
  • Phone: 209-988-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813001059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: