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General NPI Number Information
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NPI Number | 1881919553
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Entity Type | Organization
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Legal Business Name | VABODE
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 1761 CHURCH ST
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City | NORFOLK
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State | VA
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Zip | 23504-2313
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Country | US
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Telephone | 757-202-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 VOLVO PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8120
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Country | US
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Telephone | 757-202-1610
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MISS IFE MICHELLE MILLIGAN
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Credential | LCSW
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Telephone | 757-202-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 09040006963
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License Number State | VA
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