Healthcare Provider Details

I. General information

NPI: 1366265001
Provider Name (Legal Business Name): JEANNE MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

IV. Provider business mailing address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

V. Phone/Fax

Practice location:
  • Phone: 757-993-8650
  • Fax:
Mailing address:
  • Phone: 757-993-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0730000846
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: