Provider Demographics
NPI:1851640866
Name:THE PREVENTION SPECIALISTS LLC
Entity Type:Organization
Organization Name:THE PREVENTION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:LETITIA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, RD, CDE
Authorized Official - Phone:340-719-2770
Mailing Address - Street 1:PO BOX 5337
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5337
Mailing Address - Country:US
Mailing Address - Phone:340-719-2770
Mailing Address - Fax:340-719-8338
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:SUITE 1B
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-719-2770
Practice Address - Fax:340-719-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-18436-3L133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIQ-38633Medicare UPIN
VI005-7117Medicare PIN