Healthcare Provider Details

I. General information

NPI: 1568331692
Provider Name (Legal Business Name): MCRON ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 MAPLE CLUSTER CT
VIRGINIA BEACH VA
23462-7195
US

IV. Provider business mailing address

5540 MAPLE CLUSTER CT
VIRGINIA BEACH VA
23462-7195
US

V. Phone/Fax

Practice location:
  • Phone: 757-472-3200
  • Fax: 757-497-3785
Mailing address:
  • Phone: 757-472-3200
  • Fax: 757-497-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: OKO OKEBULU NWOGBURU
Title or Position: CEO
Credential:
Phone: 757-472-3200