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General NPI Number Information
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NPI Number | 1528856705
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Entity Type | Organization
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Legal Business Name | ALIS FAMILY PSYCHIATRY, LLC
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 6350 CENTER DR STE 102
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City | NORFOLK
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State | VA
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Zip | 23502-4107
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Country | US
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Telephone | 503-922-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 729 13TH ST
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-4316
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Country | US
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Telephone | 412-638-5490
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JESSICA LATHROP
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Credential |
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Telephone | 352-801-1726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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