Healthcare Provider Details

I. General information

NPI: 1417616186
Provider Name (Legal Business Name): INTERSECTIONS IN ADVOCACY CONSULTATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PEAR AVE
NEWPORT NEWS VA
23607-5523
US

IV. Provider business mailing address

110 COLISEUM XING # 5028
HAMPTON VA
23666-5971
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-8879
  • Fax:
Mailing address:
  • Phone: 757-645-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BELL
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 757-645-8879