Organization
MARY'S HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL CLANTON (CEO)
(757) 529-8844
Entity
Organization
Contact information
Practice address
4020 PORTSMOUTH BLVD, CHESAPEAKE, VA 23321-2126
(757) 529-8844
Mailing address
4020 PORTSMOUTH BLVD, CHESAPEAKE, VA 23321-2126
(757) 529-8844
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3827
LICENSE
VA
Enumeration date
09/13/2022
Last updated
10/11/2024
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