Provider Demographics
NPI:1831901503
Name:MEWBOURN, ANNA JOSEPHINE
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:JOSEPHINE
Last Name:MEWBOURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4466
Mailing Address - Country:US
Mailing Address - Phone:906-281-4637
Mailing Address - Fax:
Practice Address - Street 1:4216 VIRGINIA BEACH BLVD STE 220
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1297
Practice Address - Country:US
Practice Address - Phone:757-202-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor