Healthcare Provider Details

I. General information

NPI: 1073421913
Provider Name (Legal Business Name): OF SELF & SPIRIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E OCEAN VIEW AVE APT 432
NORFOLK VA
23503-1785
US

IV. Provider business mailing address

719 E OCEAN VIEW AVE APT 432
NORFOLK VA
23503-1785
US

V. Phone/Fax

Practice location:
  • Phone: 858-988-9755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: VERISHA COLEMAN
Title or Position: OWNER
Credential:
Phone: 858-988-9755