Organization
VILLAGE RESTORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA TRAVERS DENNIS MA, EDS, LPC (EXECUTIVE ADMINISTRATOR)
(757) 218-2507
Entity
Organization
Contact information
Practice address
550 DENBIGH BLVD, NEWPORT NEWS, VA 23608-4240
(757) 218-2507
Mailing address
PO BOX 15194, NEWPORT NEWS, VA 23608-0023
(757) 218-2507
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
0701004205
VA
251S00000X
Community/Behavioral Health Agency
Primary
0701004205
VA
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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