Healthcare Provider Details

I. General information

NPI: 1366238602
Provider Name (Legal Business Name): JORDAN CUMBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN HINES

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 CLAIBORNE SQ E STE 334
HAMPTON VA
23666-2074
US

IV. Provider business mailing address

908 SALISBURY GRN
VIRGINIA BEACH VA
23452-6123
US

V. Phone/Fax

Practice location:
  • Phone: 757-406-7397
  • Fax: 877-831-7109
Mailing address:
  • Phone: 757-406-7397
  • Fax: 877-831-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005357
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: