Provider Demographics
NPI:1558876268
Name:VITA BELLA COUNSELING
Entity Type:Organization
Organization Name:VITA BELLA COUNSELING
Other - Org Name:ANTONINA VITALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-627-5313
Mailing Address - Street 1:4951 FENTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6923
Mailing Address - Country:US
Mailing Address - Phone:917-627-5313
Mailing Address - Fax:757-282-2546
Practice Address - Street 1:4732 LONGHILL RD STE 3202
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1586
Practice Address - Country:US
Practice Address - Phone:757-758-6635
Practice Address - Fax:757-282-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA230356841Medicaid