Provider Demographics
NPI:1265273197
Name:MILES, VINCENT EDWARD JR
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:EDWARD
Last Name:MILES
Suffix:JR
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 1:908 KEMP XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5004
Mailing Address - Country:US
Mailing Address - Phone:757-770-6360
Mailing Address - Fax:
Practice Address - Street 1:908 KEMP XING
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5004
Practice Address - Country:US
Practice Address - Phone:757-770-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733005855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health