Provider Demographics
NPI:1619323862
Name:WHITESTONE PRAYER MINISTRIES
Entity Type:Organization
Organization Name:WHITESTONE PRAYER MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:757-627-1967
Mailing Address - Street 1:5000 PRESTWICK ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3324
Mailing Address - Country:US
Mailing Address - Phone:757-627-1967
Mailing Address - Fax:
Practice Address - Street 1:645 CHURCH ST STE 205
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1712
Practice Address - Country:US
Practice Address - Phone:757-239-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619323862Medicaid