Healthcare Provider Details

I. General information

NPI: 1245966498
Provider Name (Legal Business Name): MARITES EXUME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAI LEXUME

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 SETTLERS LANDING RD, WILLIE O. LAWTON BUILDING SUITE G
HAMPTON VA
23669
US

IV. Provider business mailing address

238 BRADMERE LOOP
NEWPORT NEWS VA
23608-1090
US

V. Phone/Fax

Practice location:
  • Phone: 757-727-5617
  • Fax: 757-637-2375
Mailing address:
  • Phone: 619-792-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: