Healthcare Provider Details

I. General information

NPI: 1619325727
Provider Name (Legal Business Name): DFAS-CL/JFLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 JOHN PAUL JONES CIR MENTAL HEALTH TRAINING
PORTSMOUTH VA
23708-5000
US

IV. Provider business mailing address

626 JOHN PAUL JONES CIR MENTAL HEALTH TRAINING
PORTSMOUTH VA
23708-5000
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FRANKS
Title or Position: INTERNSHIP TRAINING DIRECTOR
Credential: PSY.D.
Phone: 757-953-7641