Individual
SANDRA WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
37465 GENERAL MAHONE BLVD, IVOR, VA 23866-3017
(757) 859-9431
Mailing address
37465 GENERAL MAHONE BLVD, IVOR, VA 23866-3017
(757) 859-9431
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
06/05/2015
Last updated
06/05/2015
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