Healthcare Provider Details

I. General information

NPI: 1760998629
Provider Name (Legal Business Name): EMILY FERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 01/11/2022
Reactivation Date: 01/24/2022

III. Provider practice location address

9 MANHATTAN SQ STE B
HAMPTON VA
23666-6263
US

IV. Provider business mailing address

428 DARE RD
YORKTOWN VA
23692-2903
US

V. Phone/Fax

Practice location:
  • Phone: 757-284-3997
  • Fax:
Mailing address:
  • Phone: 757-559-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56755
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: