Provider Demographics
NPI:1265204168
Name:PRAYER, BOBBY
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:PRAYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 SEDIUM LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2747
Mailing Address - Country:US
Mailing Address - Phone:757-729-8450
Mailing Address - Fax:
Practice Address - Street 1:318 SEDIUM LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2747
Practice Address - Country:US
Practice Address - Phone:757-729-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8588-08-011251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services