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General NPI Number Information
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NPI Number | 1407545882
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Entity Type | Individual
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Provider Name | REGINA AUSTIN-FORD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 3872 AVA WAY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-2204
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Country | US
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Telephone | 757-802-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 3872 AVA WAY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-2204
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Country | US
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Telephone | 757-802-2149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 6503
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 6503
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License Number State | VA
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