Provider Demographics
NPI:1861185308
Name:WEAVER, ALECIA
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:WEAVER
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 1:3291 PRICES FORK BLVD APT 216
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3691
Mailing Address - Country:US
Mailing Address - Phone:757-353-5875
Mailing Address - Fax:
Practice Address - Street 1:485 S INDEPENDENCE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1129
Practice Address - Country:US
Practice Address - Phone:757-353-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities