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General NPI Number Information
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NPI Number | 1457715476
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Entity Type | Organization
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Legal Business Name | UNITY OUTREACH MINISTRIES OF AMERICA, INC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 1128 LONDON BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2246
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Country | US
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Telephone | 757-399-0418
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Fax | 757-393-1059
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Provider Business Mailing Address
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Address Line | 1122 LONDON BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2246
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Country | US
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Telephone | 757-393-1182
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Fax | 757-393-1059
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. EARLE WILLIAMS
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Credential | PSYD
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Telephone | 757-393-1182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001748
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License Number State | VA
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