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General NPI Number Information
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NPI Number | 1376092932
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Entity Type | Organization
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Legal Business Name | ANTHONY NICHOLS CONSULTING & EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 389 GEORGETOWN LOOP
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-2773
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Country | US
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Telephone | 757-329-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 242 W 26TH ST
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City | NORFOLK
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State | VA
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Zip | 23517-1312
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Country | US
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Telephone | 757-556-6848
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. TAMARA FREEMAN
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Credential | PH.D CCC-SLP
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Telephone | 757-329-0602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202005282
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License Number State | VA
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