Provider Demographics
NPI:1619519931
Name:SANTIFUL, ARRIELLE DEZIURE
Entity Type:Individual
Prefix:
First Name:ARRIELLE
Middle Name:DEZIURE
Last Name:SANTIFUL
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 1:17 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-1031
Mailing Address - Country:US
Mailing Address - Phone:757-849-8190
Mailing Address - Fax:
Practice Address - Street 1:648 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5206
Practice Address - Country:US
Practice Address - Phone:757-716-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician