Organization
BLESSED SUPPORT PROFESSIONALS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBENEZER BANAHENE (PRESIDENT)
(703) 926-9739
Entity
Organization
Contact information
Practice address
14511 JEFFERSON DAVIS HWY # A, WOODBRIDGE, VA 22191-2807
(703) 494-6014
Mailing address
14511 JEFFERSON DAVIS HWY # A, WOODBRIDGE, VA 22191-2807
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/14/2019
Last updated
05/14/2019
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