Healthcare Provider Details

I. General information

NPI: 1619527645
Provider Name (Legal Business Name): FROM THE DESK OF DR. YANCEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 BENNETTS PASTURE RD #5354
SUFFOLK VA
23435-2689
US

IV. Provider business mailing address

PO BOX 5354
SUFFOLK VA
23435-0354
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-2475
  • Fax: 888-663-2475
Mailing address:
  • Phone: 888-663-2475
  • Fax: 888-663-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFINEE YANCEY
Title or Position: CLINICAL SPECIALIST
Credential: LPC
Phone: 757-717-9569