Provider Demographics
NPI:1073332615
Name:MARIEHEAVENLEE BLESSINGS LLC
Entity type:Organization
Organization Name:MARIEHEAVENLEE BLESSINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:ALTERISS
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, QMHP
Authorized Official - Phone:804-955-7134
Mailing Address - Street 1:3707 PENNYWEIGHT CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1977
Mailing Address - Country:US
Mailing Address - Phone:804-955-7134
Mailing Address - Fax:
Practice Address - Street 1:3707 PENNYWEIGHT CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-1977
Practice Address - Country:US
Practice Address - Phone:804-955-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health