| Your Business Ccc | |
|
424 Market St Ste 100 Suffolk VA 23434-5249 | |
| (757) 347-0703 | |
| (757) 273-6514 |
| Full Name | Your Business Ccc |
|---|---|
| Speciality | Social Worker |
| Location | 424 Market St Ste 100, Suffolk, Virginia |
| Authorized Official Name and Position | Whitney Smith (CEO) |
| Authorized Official Contact | 7573470703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Business Ccc 424 Market St Ste 100 Suffolk VA 23434-5249 Ph: (757) 347-0703 | Your Business Ccc 424 Market St Ste 100 Suffolk VA 23434-5249 Ph: (757) 347-0703 |
| NPI Number | 1922695592 |
|---|---|
| Provider Enumeration Date | 12/29/2020 |
| Last Update Date | 04/29/2025 |
| Certification Date | 04/29/2025 |
| Medicare PECOS PAC ID | 7416347182 |
|---|---|
| Medicare Enrollment ID | O20211213000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922695592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Whitney Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760930168 PECOS PAC ID: 8325438096 Enrollment ID: I20211213001031 |
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