Individual
TOSHIBA ANTONIA FENTRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3755 E VIRGINIA BEACH BLVD, NORFOLK, VA 23502-3238
(757) 823-1600
Mailing address
2622 BALLENTINE BLVD, NORFOLK, VA 23509-2304
(757) 831-2741
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701008414
VA
101YM0800X
Mental Health Counselor
0701008414
VA
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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