Individual
REGINA AUSTIN-FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3872 AVA WAY, VIRGINIA BEACH, VA 23456-2204
(757) 802-2149
Mailing address
3872 AVA WAY, VIRGINIA BEACH, VA 23456-2204
(757) 802-2149
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6503
VA
305R00000X
Preferred Provider Organization
6503
VA
Other
Enumeration date
05/02/2023
Last updated
05/03/2023
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