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General NPI Number Information
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NPI Number | 1982985420
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Entity Type | Organization
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Legal Business Name | INNER CIRCLE, INCORPORATED
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 2204 EXECUTIVE DR STE A
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City | HAMPTON
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State | VA
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Zip | 23666-6602
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Country | US
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Telephone | 757-644-3989
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Fax | 757-234-6979
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Provider Business Mailing Address
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Address Line | 2204 EXECUTIVE DR STE A
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City | HAMPTON
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State | VA
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Zip | 23666-6602
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Country | US
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Telephone | 757-644-3989
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Fax | 757-234-6979
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Authorized Official
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Title or Position | CEO
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Name | VALDIMIR HANDY
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Credential |
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Telephone | 757-644-3989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1693
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License Number State | VA
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