49D1011231 CLIA NUMBER - TIDEWATER PSYCHOTHERAPY SERVICES

Laboratory Demographics

  • CLIA Code: 49D1011231
  • Facility Name: TIDEWATER PSYCHOTHERAPY SERVICES
  • Facility Address: 260 GRAYSON ROAD - SUITE 100
    VIRGINIA BEACH, VA
    ZIP 23462
  • Facility Phone: 757 497-3670
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEVEN G. CUNNINGHAM
  • NPI Number: 1164536496
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 49D1011231
LAB Type Physician Office
Facility Name TIDEWATER PSYCHOTHERAPY SERVICES
Street 260 GRAYSON ROAD - SUITE 100
City VIRGINIA BEACH
State VA
ZIP 23462
Phone 757 497-3670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Physician Office
Lab Director STEVEN G. CUNNINGHAM

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This page was last updated on: 9/29/2025