1386351716 NPI number — MYRIAD EDUCATIONAL TRAINING AND SERVICES

Table of content: DR. PHOEBE B. SPECK PH.D., LICSW (NPI 1861407272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386351716 NPI number — MYRIAD EDUCATIONAL TRAINING AND SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYRIAD EDUCATIONAL TRAINING AND SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386351716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4831 COLUMBUS ST # 62982
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-6703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-955-1191
Provider Business Mailing Address Fax Number:
888-797-8187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MYRIAD EDUCATIONAL TRAINING AND SERVICES, LLC
Provider Second Line Business Practice Location Address:
2512 ARCHDALE DR
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-955-1191
Provider Business Practice Location Address Fax Number:
888-797-8187
Provider Enumeration Date:
11/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
RA'IFA
Authorized Official First Name:
MANSA
Authorized Official Middle Name:
KUUMBA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-955-1191

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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