Healthcare Provider Details

I. General information

NPI: 1245311703
Provider Name (Legal Business Name): CARPE DIEM OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TEJO LN SUITE 105
CHESAPEAKE VA
23321-5258
US

IV. Provider business mailing address

3500 TEJO LN SUITE 105
CHESAPEAKE VA
23321-5258
US

V. Phone/Fax

Practice location:
  • Phone: 757-638-5500
  • Fax: 757-638-7740
Mailing address:
  • Phone: 757-638-5500
  • Fax: 757-638-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number010-02-029
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN ELIOT FAIRCLOTH
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 757-638-5500