Provider Demographics
NPI:1457715476
Name:UNITY OUTREACH MINISTRIES OF AMERICA, INC
Entity Type:Organization
Organization Name:UNITY OUTREACH MINISTRIES OF AMERICA, INC
Other - Org Name:NEW VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-393-1182
Mailing Address - Street 1:1122 LONDON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2246
Mailing Address - Country:US
Mailing Address - Phone:757-393-1182
Mailing Address - Fax:757-393-1059
Practice Address - Street 1:1128 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2246
Practice Address - Country:US
Practice Address - Phone:757-399-0418
Practice Address - Fax:757-393-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty