=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497416697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED TRAUMA RECOVERY & MENTAL HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2022
-----------------------------------------------------
Last Update Date | 09/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11815 FOUNTAIN WAY STE 300
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-335-6485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11815 FOUNTAIN WAY STE 300
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-335-6485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST, OWNER
-----------------------------------------------------
Name | DR. ALEXIS ZORNITTA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 757-335-6485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------