Provider Demographics
NPI:1588962930
Name:INNERVATION,LLC
Entity type:Organization
Organization Name:INNERVATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, EDS, QMHP, CSAC
Authorized Official - Phone:757-673-4430
Mailing Address - Street 1:3100 LONDON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3402
Mailing Address - Country:US
Mailing Address - Phone:757-673-4430
Mailing Address - Fax:757-673-4432
Practice Address - Street 1:3100 LONDON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3402
Practice Address - Country:US
Practice Address - Phone:757-673-4430
Practice Address - Fax:757-673-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health