Provider Demographics
NPI:1992370522
Name:STREAM-LIGHNING YOU THERAPEUTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:STREAM-LIGHNING YOU THERAPEUTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUQUALA
Authorized Official - Middle Name:V
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-218-2446
Mailing Address - Street 1:11815 FOUNTAIN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4448
Mailing Address - Country:US
Mailing Address - Phone:757-218-2446
Mailing Address - Fax:
Practice Address - Street 1:11815 FOUNTAIN WAY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4448
Practice Address - Country:US
Practice Address - Phone:757-218-2446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty