Provider Demographics
NPI:1720785256
Name:SALOME, KHALEMA
Entity Type:Individual
Prefix:
First Name:KHALEMA
Middle Name:
Last Name:SALOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KHALEMA
Other - Middle Name:SALOME
Other - Last Name:SHABAZZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:569 S ROSEMONT RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4133
Mailing Address - Country:US
Mailing Address - Phone:757-403-0276
Mailing Address - Fax:
Practice Address - Street 1:3101 MAGIC HOLLOW BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3010
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician