Healthcare Provider Details

I. General information

NPI: 1891678454
Provider Name (Legal Business Name): GERROD ERVIN CRAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAGIC HOLLOW BLVD
VIRGINIA BEACH VA
23453-3010
US

IV. Provider business mailing address

4214 FLOWERFIELD RD APT D
NORFOLK VA
23518-4745
US

V. Phone/Fax

Practice location:
  • Phone: 757-639-2218
  • Fax:
Mailing address:
  • Phone: 757-698-1805
  • 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: