Healthcare Provider Details

I. General information

NPI: 1124537360
Provider Name (Legal Business Name): ROSE BEHAVIORAL HEALTHCARE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024175122
License Number StateVA

VIII. Authorized Official

Name: ALICIA NICOLE ROSE
Title or Position: MANAGER
Credential: CNS, NP
Phone: 757-460-4655