Provider Demographics
NPI:1043963226
Name:ENRIQUEZ, NATALY
Entity Type:Individual
Prefix:
First Name:NATALY
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22056 BREWERS NECK BLVD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3504
Mailing Address - Country:US
Mailing Address - Phone:408-209-2931
Mailing Address - Fax:
Practice Address - Street 1:600 THIMBLE SHOALS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2768
Practice Address - Country:US
Practice Address - Phone:757-690-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst