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General NPI Number Information
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NPI Number | 1750262184
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Entity Type | Individual
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Provider Name | MRS. JACKITA RALPH
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1932 KEMPSVILLE RD STE 107
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6953
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Country | US
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Telephone | 757-689-1183
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Fax | 757-689-6814
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Provider Business Mailing Address
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Address Line | 417 CLARA DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-7031
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Country | US
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Telephone | 757-805-1827
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Fax | 757-689-6814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 4450
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License Number State | VA
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