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General NPI Number Information
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NPI Number | 1477882744
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Entity Type | Organization
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Legal Business Name | INDIVIDUALS & OPPORTUNITIES DAY SUPPORT
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 800 TIDEWATER DR
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City | NORFOLK
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State | VA
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Zip | 23504-3326
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Country | US
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Telephone | 757-965-8693
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Fax | 757-502-4960
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Provider Business Mailing Address
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Address Line | 800 TIDEWATER DR
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City | NORFOLK
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State | VA
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Zip | 23504-3326
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Country | US
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Telephone | 757-965-8693
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Fax | 757-502-4960
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL PROGRAMS
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Name | MS. NATASHA FEDYSZYN-CARR
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Credential | MAQMRP, QMHP
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Telephone | 757-965-8669
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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 | 346-05-011
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License Number State | VA
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