=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710474440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOARING EAGLES VA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9842 LORI RD STE 100
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-6656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-745-1402
-----------------------------------------------------
Fax | 804-409-1702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9842 LORI RD STE 100
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-6656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-745-1402
-----------------------------------------------------
Fax | 804-409-1702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MRS. ONI HUNTER
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 804-201-6188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------