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General NPI Number Information
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NPI Number | 1356448930
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Entity Type | Organization
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Legal Business Name | EAST END ACADEMY, INC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2000 27TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4912
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Country | US
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Telephone | 757-247-0039
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Fax | 757-247-0158
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Provider Business Mailing Address
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Address Line | 2000 27TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4912
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Country | US
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Telephone | 757-247-0039
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Fax | 757-247-0158
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE MANAGER
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Name | MRS. JACQUELINE CARLETHIA COOPER
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Credential |
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Telephone | 757-247-0039
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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 | 320
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License Number State | VA
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