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General NPI Number Information
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NPI Number | 1922793686
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Entity Type | Organization
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Legal Business Name | INNOVATIVE OPTIONS INCORPORATED
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1216 GRANBY ST STE 206
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City | NORFOLK
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State | VA
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Zip | 23510-2622
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Country | US
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Telephone | 757-237-8460
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Fax | 478-288-7832
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Provider Business Mailing Address
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Address Line | 3915 CASCADE RD SW STE T-138
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City | ATLANTA
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State | GA
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Zip | 30331-2009
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Country | US
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Telephone | 757-237-8460
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ANTOINETTE NUMITAL THORNTON
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Credential | PH.D. LCSW
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Telephone | 757-237-8460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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