Organization
EARLY CHILDHOOD INTERVENTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAH ANTIONETTE PETITE (CEO)
(757) 287-0680
Entity
Organization
Contact information
Practice address
4002 MEADOWS CT, SUFFOLK, VA 23434-8357
(757) 287-0680
Mailing address
4002 MEADOWS CT, SUFFOLK, VA 23434-8357
(757) 287-0680
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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