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General NPI Number Information
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NPI Number | 1104505817
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Entity Type | Organization
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Legal Business Name | VITALITY COUNSELING AND ART THERAPY, PLLC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 5600 PENNY CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6512
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Country | US
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Telephone | 757-729-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 PENNY CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6512
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Country | US
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Telephone | 757-729-2051
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MONIKA LEILA ISIP
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Credential | LPC, ATR
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Telephone | 757-729-2051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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