Provider Demographics
NPI:1194468421
Name:BIRDEN, MAYA (LRIC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:BIRDEN
Suffix:
Gender:F
Credentials:LRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 PAINE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5215
Mailing Address - Country:US
Mailing Address - Phone:540-656-8098
Mailing Address - Fax:
Practice Address - Street 1:1228 PROGRESSIVE DR STE 201
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2846
Practice Address - Country:US
Practice Address - Phone:757-436-5601
Practice Address - Fax:855-410-0727
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional