TIDEWATER MOBILE MEDICINE PLLC NPI 1225527351

NPI Information

NPI: 1225527351
Provider Name: TIDEWATER MOBILE MEDICINE, PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Doing Business As: AUTHENTIC SELF COUNSELING SERVICES
Address: 3520 HIGH ST STE 100
PORTSMOUTH, VA
ZIP 23707
Phone: (757) 977-9675

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NPI Details

TIDEWATER MOBILE MEDICINE, PLLC is a family medicine in Portsmouth, VA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TIDEWATER MOBILE MEDICINE, PLLC NPI is 1225527351. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Authentic Self Counseling Services.

The provider's business location address is:

3520 HIGH ST STE 100
PORTSMOUTH, VA
ZIP 23707-126
Phone: (757) 977-9675
Fax: (757) 483-8099

The provider's authorized official is Jimmy Cooper .
The authorized official title is Ceo/owner and has the following contact phone number (757) 977-9675.

The enumeration date for this NPI number is 5/3/2018 and was last updated on 1/21/2022.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
2	1041C0700X	Social Worker	Clinical			No
3	261QP2300X	Clinic/Center	Primary Care	46193	VIRGINIA	No
4	343900000X	Non-emergency Medical Transport (VAN)				No
5	207Q00000X	Family Medicine				Yes

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: 3/30/2025

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