Provider Demographics
NPI:1881576130
Name:CARY, IMANI
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:CARY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CAPE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0099
Mailing Address - Country:US
Mailing Address - Phone:571-660-0937
Mailing Address - Fax:
Practice Address - Street 1:802 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4479
Practice Address - Country:US
Practice Address - Phone:757-907-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician