Individual
MRS. MIRIAM THERESA ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3216 HIGH ST, PORTSMOUTH, VA 23707-3318
(757) 610-1643
(757) 673-4607
Mailing address
3216 HIGH ST, PORTSMOUTH, VA 23707-3318
(757) 610-1643
(757) 673-4607
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982071452
—
VA
Enumeration date
08/16/2024
Last updated
08/16/2024
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