Healthcare Provider Details

I. General information

NPI: 1205731312
Provider Name (Legal Business Name): MRS. CALIMBA BLAIZE LUMPKIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 LOUISA AVE
VIRGINIA BEACH VA
23454-4669
US

IV. Provider business mailing address

825 POLLARD ST
NORFOLK VA
23504-1901
US

V. Phone/Fax

Practice location:
  • Phone: 757-633-8372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: