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General NPI Number Information
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NPI Number | 1588439814
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Entity Type | Organization
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Legal Business Name | CINMARCO
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1899 BILLINGSGATE CIR STE A
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City | HENRICO
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State | VA
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Zip | 23238-4243
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Country | US
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Telephone | 804-938-9898
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Fax | 804-509-2403
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Provider Business Mailing Address
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Address Line | 9702 GAYTON RD # 219
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City | HENRICO
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State | VA
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Zip | 23238-4907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DOMINIQUE HUMPHREY
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Credential |
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Telephone | 804-982-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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