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General NPI Number Information
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NPI Number | 1700785656
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Entity Type | Organization
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Legal Business Name | MAE'S ENRICHED HANDS LLC
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 126 HOUGH AVE
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City | NORFOLK
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State | VA
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Zip | 23523-1118
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Country | US
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Telephone | 757-870-0457
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Fax |
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Provider Business Mailing Address
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Address Line | 780 LYNNHAVEN PKWY STE 370
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7353
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Country | US
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Telephone | 757-870-0457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CEDRIC JAMES ODOM
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Credential |
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Telephone | 757-870-0457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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