| Robert T Lee Foundation LLC | |
|
610 Thimble Shoals Blvd # 403 Newport News VA 23606-2573 | |
| (901) 672-2228 | |
| Not Available |
| Full Name | Robert T Lee Foundation LLC |
|---|---|
| Speciality | Social Worker |
| Location | 610 Thimble Shoals Blvd # 403, Newport News, Virginia |
| Authorized Official Name and Position | Jarvis Donnell Lee (CEO) |
| Authorized Official Contact | 9016722228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert T Lee Foundation LLC 31 Harwood Ave Hampton VA 23664-1044 Ph: (901) 672-2228 | Robert T Lee Foundation LLC 610 Thimble Shoals Blvd # 403 Newport News VA 23606-2573 Ph: (901) 672-2228 |
| NPI Number | 1982360079 |
|---|---|
| Provider Enumeration Date | 11/12/2021 |
| Last Update Date | 04/09/2022 |
| Certification Date | 04/09/2022 |
| Medicare PECOS PAC ID | 5092106534 |
|---|---|
| Medicare Enrollment ID | O20211217000322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982360079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
| Provider Name | Jarvis Donnell Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740765437 PECOS PAC ID: 8527459064 Enrollment ID: I20211217000427 |
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