Western Tidewater Community Mental

NPI 1689615296 - Clinic/Center - 261QM0855X

NPI Details
NPI 1689615296
Enumeration Date 06/08/2006
Last Updated 01/12/2015
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name DEMETRIOS DEMETRIOS
Position EXECUTIVE DIRECTOR
Phone (757) 255-7117
Fax (757) 255-7139
Practice Location
5268 GODWIN BLVD
SUFFOLK VA, 23434-8135, US
Phone (757) 255-7117
Fax (757) 255-7139
Business Location
5268 GODWIN BLVD
SUFFOLK VA, 23434-8135, US
Phone (757) 255-7117
Fax (757) 255-7139
Toxanomy
Taxonomy Code 261QM0855X
License State Virginia
License Number 084-02-029
Remove 1689615296 NPI Number
 

According to our database, Western Tidewater Community Mental NPI is 1689615296, taxonomy code is 261QM0855X and license number is 084-02-029, license state is located at Virginia. Western Tidewater Community Mental physically located at 5268 Godwin Blvd, Suffolk VA, 23434-8135. NPI Number 1033115704 has the healthcare provider type.

Sponsored links

1689615296 NPI number is provided on an as is basis without warranty of any kind. 1689615296 is maintained by the National Plan & Provider Enumeration System. The contents of Western Tidewater Community Mental are for informational purposes only.