Healthcare Provider Details

I. General information

NPI: 1083161053
Provider Name (Legal Business Name): SIMONE DREHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/17/2021
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CHARLOTTE DR
NEWPORT NEWS VA
23601-1341
US

IV. Provider business mailing address

7320 WARWICK BLVD
NEWPORT NEWS VA
23607-1598
US

V. Phone/Fax

Practice location:
  • Phone: 757-224-1488
  • Fax: 757-224-1460
Mailing address:
  • Phone: 757-224-1488
  • Fax: 757-257-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013029
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: