=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942010012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W.H.E.E. REPEACE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3108 TYRE NECK RD STE C
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-4532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-610-1766
-----------------------------------------------------
Fax | 757-330-6683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3108 TYRE NECK RD STE C
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-4532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-610-1766
-----------------------------------------------------
Fax | 757-330-6683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHERITHA BELLAMY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-610-1766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------