Provider Demographics
NPI:1003601204
Name:SINGH, SUPREET
Entity type:Individual
Prefix:
First Name:SUPREET
Middle Name:
Last Name:SINGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 MOTT LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-1467
Mailing Address - Country:US
Mailing Address - Phone:757-715-7302
Mailing Address - Fax:
Practice Address - Street 1:5033 GEORGE WASHINGTON MEM HWY STE C
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2510
Practice Address - Country:US
Practice Address - Phone:757-715-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-301845106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician