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General NPI Number Information
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NPI Number | 1659883403
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Entity Type | Organization
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Legal Business Name | ASB, INC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 114 N MAIN ST STE 102B
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City | SUFFOLK
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State | VA
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Zip | 23434-4564
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Country | US
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Telephone | 757-809-5376
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Fax | 757-809-5374
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Provider Business Mailing Address
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Address Line | 114 N MAIN ST STE 102B
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City | SUFFOLK
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State | VA
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Zip | 23434-4564
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Country | US
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Telephone | 800-608-0371
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Fax | 800-608-9427
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Authorized Official
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Title or Position | OWNER/NEUROPSYCHOLOGIST
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Name | ANNELI S BARRIOS
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Credential | PHD
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Telephone | 800-608-0371
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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 | 0810004561
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License Number State | VA
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