Organization
AMAZING STAR GROUP HOME CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ETUTE (PRES/CEO)
(757) 706-2273
Entity
Organization
Contact information
Practice address
861 GLENROCK RD, SUITE 114, NORFOLK, VA 23502-3720
(757) 706-2273
(757) 893-9266
Mailing address
861 GLENROCK RD, SUITE 114, NORFOLK, VA 23502-3720
(757) 706-2273
(757) 893-9266
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Enumeration date
01/26/2016
Last updated
01/26/2016
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