Healthcare Provider Details

I. General information

NPI: 1922793686
Provider Name (Legal Business Name): INNOVATIVE OPTIONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 GRANBY ST STE 206
NORFOLK VA
23510-2622
US

IV. Provider business mailing address

3915 CASCADE RD SW STE T-138
ATLANTA GA
30331-2009
US

V. Phone/Fax

Practice location:
  • Phone: 757-237-8460
  • Fax: 478-288-7832
Mailing address:
  • Phone: 757-237-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOINETTE NUMITAL THORNTON
Title or Position: CEO
Credential: PH.D. LCSW
Phone: 757-237-8460