=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760315048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VAN BUREN MITCHELL II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 INVESTORS PL STE 106
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-1166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-996-1837
-----------------------------------------------------
Fax | 757-652-2855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 DOVER CIR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23505-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-292-5701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 0906017549
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------