Healthcare Provider Details

I. General information

NPI: 1225401375
Provider Name (Legal Business Name): EMILY BEBBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 CENTRAL BUSINESS PARK DR
NORFOLK VA
23513-2818
US

IV. Provider business mailing address

7460 CENTRAL BUSINESS PARK DR
NORFOLK VA
23513-2818
US

V. Phone/Fax

Practice location:
  • Phone: 757-644-6391
  • Fax: 757-622-2011
Mailing address:
  • Phone: 757-644-6391
  • Fax: 757-622-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: