MEDICARE: ARTEMIS THERAPEUTIC CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922613942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTEMIS THERAPEUTIC CENTER LLC

Provider Business Mailing Address
First Line	:	1425 BATTLEFIELD BLVD N STE 2182
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-9998
Country	:	US
Telephone Number	:	757-524-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 BATTLEFIELD BLVD N STE 2182
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-9998
Country	:	US
Telephone Number	:	757-453-3215
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN/ FOUNDER
Name	:	MS. NEDA SANTA LOPEZ
Credential	:	LCSW, CSAC
Telephone Number	:	757-453-3215

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	11/30/2020

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