Healthcare Provider Details

I. General information

NPI: 1730091257
Provider Name (Legal Business Name): ARIEL LEE-BRACEY VELAZQUEZ RN, PMH-BC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N WITCHDUCK RD STE 1B
VIRGINIA BEACH VA
23462-6556
US

IV. Provider business mailing address

258 N WITCHDUCK RD STE 1B
VIRGINIA BEACH VA
23462-6556
US

V. Phone/Fax

Practice location:
  • Phone: 757-385-0910
  • Fax:
Mailing address:
  • Phone: 757-385-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001285712
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: