Provider Demographics
NPI:1427319300
Name:THE FOLECK CENTER
Entity type:Organization
Organization Name:THE FOLECK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TATJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOJLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-623-0283
Mailing Address - Street 1:201 COLLEGE PLACE
Mailing Address - Street 2:#111
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:757-623-0283
Mailing Address - Fax:757-623-0339
Practice Address - Street 1:201 COLLEGE PLACE
Practice Address - Street 2:#111
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-623-0283
Practice Address - Fax:757-623-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088731223G0001X
VA04014120331223G0001X
VA04014128341223G0001X
VA04014131401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty