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General NPI Number Information
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NPI Number | 1447944426
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Entity Type | Organization
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Legal Business Name | ENGAGED N PURPOSE
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 4400 BRUCE FARM DR
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City | SUFFOLK
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State | VA
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Zip | 23435-1255
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Country | US
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Telephone | 757-537-2919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5012
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City | SUFFOLK
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State | VA
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Zip | 23435-0012
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Country | US
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Telephone | 757-537-2919
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | FONDA ALTHEA LYLES
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Credential | LCSW
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Telephone | 757-537-2919
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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 |
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License Number State |
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