Healthcare Provider Details

I. General information

NPI: 1336084961
Provider Name (Legal Business Name): ALEXIS ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX ADAMS

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LYNNHAVEN PKWY STE 400
VIRGINIA BEACH VA
23452-7332
US

IV. Provider business mailing address

780 LYNNHAVEN PKWY STE 400
VIRGINIA BEACH VA
23452-7332
US

V. Phone/Fax

Practice location:
  • Phone: 877-276-0626
  • Fax:
Mailing address:
  • Phone: 877-276-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-473581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: