Healthcare Provider Details

I. General information

NPI: 1780227165
Provider Name (Legal Business Name): ANGELICA TYREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DR STE 200
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

208 THOROUGHBRED LN APT 101
CHESAPEAKE VA
23320-3062
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax:
Mailing address:
  • Phone: 804-943-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: