Healthcare Provider Details

I. General information

NPI: 1417379561
Provider Name (Legal Business Name): DR. FELICIA DYKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CASTLE HAVEN RD
HAMPTON VA
23666-6032
US

IV. Provider business mailing address

10 CASTLE HAVEN RD
HAMPTON VA
23666-6032
US

V. Phone/Fax

Practice location:
  • Phone: 757-469-4112
  • Fax: 757-224-3411
Mailing address:
  • Phone: 757-469-4112
  • Fax: 757-224-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: