Healthcare Provider Details

I. General information

NPI: 1750198214
Provider Name (Legal Business Name): P4P BEHAVIOR HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 COLLEGE PARK SQ STE 210
VIRGINIA BEACH VA
23464-3622
US

IV. Provider business mailing address

6465 COLLEGE PARK SQ STE 210
VIRGINIA BEACH VA
23464-3622
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-8356
  • Fax: 757-257-3450
Mailing address:
  • Phone: 757-336-8356
  • Fax: 757-257-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DR. RHANADA VAZQUEZ
Title or Position: CEO
Credential: DSL, LPC
Phone: 757-301-1160