Healthcare Provider Details

I. General information

NPI: 1669151882
Provider Name (Legal Business Name): ACHIEVE AND SUCCEED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 HASKINS DR
SUFFOLK VA
23434-2600
US

IV. Provider business mailing address

860 HASKINS DR
SUFFOLK VA
23434-2600
US

V. Phone/Fax

Practice location:
  • Phone: 757-323-2347
  • Fax:
Mailing address:
  • Phone: 757-323-2347
  • Fax:

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 Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RATONYA NICOLE ENSLEY
Title or Position: DIRECTOR
Credential:
Phone: 757-323-2347