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General NPI Number Information
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NPI Number | 1417350687
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Entity Type | Organization
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Legal Business Name | UNITED INTERVENTIONS INC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 140 W WASHINGTON ST SUITE 102B
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City | SUFFOLK
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State | VA
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Zip | 23434-5254
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Country | US
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Telephone | 757-925-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 140 W WASHINGTON ST SUITE 102B
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City | SUFFOLK
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State | VA
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Zip | 23434-5254
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Country | US
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Telephone | 757-925-3747
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Fax |
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Authorized Official
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Title or Position | OWNER/CFO
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Name | MR. JENAE JERAN HOLLEY
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Credential |
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Telephone | 252-331-3485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2155
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License Number State | VA
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