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General NPI Number Information
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NPI Number | 1427794429
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Entity Type | Organization
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Legal Business Name | EAST ARENA THERAPY, PLLC
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 283 CONSTITUTION DR STE 600
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6760
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Country | US
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Telephone | 757-740-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 109 GAINSBOROUGH SQ STE G #213
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1757
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Country | US
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Telephone | 757-570-0394
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KELLY WOODS
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Credential | MA, LPC, NCC
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Telephone | 757-570-0394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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