Healthcare Provider Details

I. General information

NPI: 1194620468
Provider Name (Legal Business Name): FATINA MCINTYRE WARREN LMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 HENNEMAN DR STE A
NORFOLK VA
23513-2401
US

IV. Provider business mailing address

5375 HENNEMAN DR STE A
NORFOLK VA
23513-2401
US

V. Phone/Fax

Practice location:
  • Phone: 757-904-0444
  • Fax: 757-866-5824
Mailing address:
  • Phone: 757-904-0444
  • Fax: 757-866-5824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906017395
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: