Healthcare Provider Details

I. General information

NPI: 1316951262
Provider Name (Legal Business Name): ALEX EMERSON DRYDEN L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 21ST ST SUITE 205
NORFOLK VA
23517-2130
US

IV. Provider business mailing address

327 W 21ST ST SUITE 205
NORFOLK VA
23517-2130
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-9852
  • Fax: 757-622-4033
Mailing address:
  • Phone: 757-622-9852
  • Fax: 757-622-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: