=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114733698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLVIEW BEHAVIORAL LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2024
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 S PARLIAMENT DR STE 106
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-551-1377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 LAKE GENEVE DR
-----------------------------------------------------
City | VA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-6483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-551-1377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JOSEPH CHERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 948-204-1345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------