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General NPI Number Information
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NPI Number | 1083373740
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Entity Type | Organization
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Legal Business Name | SUPREME HEALING PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 825 DILIGENCE DR STE 227
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4272
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Country | US
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Telephone | 757-933-5386
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Fax | 757-210-4197
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Provider Business Mailing Address
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Address Line | 825 DILIGENCE DR STE 227
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4272
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Country | US
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Telephone | 757-933-5386
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Fax | 757-210-4197
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Authorized Official
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Title or Position | PROVIDER
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Name | CHIQUITA COLLINS
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Credential |
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Telephone | 757-933-5386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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