Healthcare Provider Details

I. General information

NPI: 1821455932
Provider Name (Legal Business Name): MILESTONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 BARKINGDALE DR
VIRGINIA BEACH VA
23462-4649
US

IV. Provider business mailing address

4520 BARKINGDALE DR
VIRGINIA BEACH VA
23462-4649
US

V. Phone/Fax

Practice location:
  • Phone: 949-338-7289
  • Fax:
Mailing address:
  • Phone: 949-338-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXANDRIA G DAVIS
Title or Position: CEO
Credential:
Phone: 949-338-7289