=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700350915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MICRO-NONPROFIT NETWORK INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2019
-----------------------------------------------------
Last Update Date | 07/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1712 ROKEBY AVE
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-572-0974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1712 ROKEBY AVE
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-572-0974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/ADMINISTRATOR
-----------------------------------------------------
Name | VERONICA DAVIS MCMILLIAN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 757-572-0974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------