Provider Demographics
NPI:1215681572
Name:ORNDOFF, MICHAEL GERALD
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERALD
Last Name:ORNDOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 LYNNHAVEN PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7332
Mailing Address - Country:US
Mailing Address - Phone:757-301-9065
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNHAVEN PKWY STE 250
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-301-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906010641104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker