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General NPI Number Information
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NPI Number | 1356105001
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Entity Type | Organization
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Legal Business Name | CLARY ENTERPRISES
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 300 MONTICELLO AVE STE 285
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City | NORFOLK
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State | VA
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Zip | 23510-4407
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Country | US
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Telephone | 757-632-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S FIR AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1240
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Country | US
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Telephone | 757-632-0580
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTHONY CLARY
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Credential | REP
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Telephone | 850-384-3936
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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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