Organization Active NPI

Supreme Healing Psychological Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Newport News, VA
National Provider Identifier
1083373740
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SUPREME HEALING PSYCHOLOGICAL SERVICES
Practice address
825 Diligence Dr Ste 227
Newport News, VA 23606-4272
Phone
(757) 933-5386
Fax
(757) 210-4197
NPI assigned
Dec 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chiquita CollinsNPI 1467020339
Title
Provider
Phone
(757) 933-5386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

825 Diligence Dr Ste 227
Newport News, VA 23606-4272

Mailing address

825 Diligence Dr Ste 227
Newport News, VA 23606-4272
Phone (757) 933-5386

Other identifiers 1

IdentifierTypeStateIssuer
1467020339MedicaidVA

Other names 1

  • Supreme Healing Psychological Services, PLLC. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230324000140 VA Part B Supplier - Clinic/Group Practice 0042684540 Receives reassigned benefits from 1 practitioner
Practice locations: Newport News, VA

National Provider Directory

National Provider Directory

Locations

2019 Cunningham Dr
Ste 301
Hampton, VA 23666
Phone (757) 535-9080

2021 Executive Dr
Ste 370
Hampton, VA 23666

739 Thimble Shoals Blvd
#120052
Newport News, VA 23606

825 Diligence Dr
Ste 227
Newport News, VA 23606
Phone (757) 309-5272

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1083373740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 DILIGENCE DR STE 227",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064272",
            "telephone_number": "757-933-5386",
            "fax_number": "757-210-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 DILIGENCE DR STE 227",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064272",
            "telephone_number": "757-933-5386",
            "fax_number": "757-210-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME HEALING PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "CHIQUITA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "757-933-5386"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467020339",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supreme Healing Psychological Services, PLLC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.