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TIDEWATER PSYCHOTHERAPY SERVICES NPI 1700830742


NPI Information

NPI: 1700830742
Provider Name: TIDEWATER PSYCHOTHERAPY SERVICES
Classification: Social Worker - 104100000X
Entity Type: Organization

CLIA Number: 49D2101100

Address:
260 GRAYSON RD
SUITE 100
VIRGINIA BEACH, VA
ZIP 23462
Phone: (757) 497-3670
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TIDEWATER PSYCHOTHERAPY SERVICES is a social worker in Virginia Beach, VA. The provider is a social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. TIDEWATER PSYCHOTHERAPY SERVICES NPI is 1700830742. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

260 GRAYSON RD
SUITE 100
VIRGINIA BEACH, VA
ZIP 23462-345
Phone: (757) 497-3670
Fax: (757) 499-1947

The provider's authorized official is Louise Friedman .
The authorized official title is President, Authorizaed Offical and has the following contact phone number (757) 497-3670.

The CLIA number assigned to this NPI record is 49D2101100 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/22/2006 and was last updated on 8/21/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)204VIRGINIANo
22084P0800XPsychiatry & NeurologyPsychiatryNo
3104100000XSocial Worker2006112732RVIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11700830742MEDICAIDVIRGINIA
2CO1311MEDICARE PIN
3CO1311MEDICARE UPINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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