NPIMap

Organization Active NPI

Thimble Shoals Counseling & Therapy Center PC

Doing business as Susan C Nicholson PhD, LCSW dba Thimble Shoals Counseling & Therapy Ce

  • Clinical Social Worker
  • Newport News, VA
National Provider Identifier
1033138227
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904003048 Issued in VA
Legal business name
THIMBLE SHOALS COUNSELING & THERAPY CENTER PC
Doing business as
Susan C Nicholson PhD, LCSW dba Thimble Shoals Counseling & Therapy Ce
Practice address
703 Thimble Shoals Blvd
A3
Newport News, VA 23606-2576
Phone
(757) 873-3401
Fax
(757) 223-1165
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Susan C Nicholson, CSWNPI 1023232626
Title
Owner, President
Phone
(757) 869-2361

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 0904003048 VA Primary

Addresses

Primary practice location

703 Thimble Shoals Blvd
A3
Newport News, VA 23606-2576

Mailing address

203 Woodburne LN
Newport News, VA 23602-8363
Phone (757) 869-2361

Other identifiers 10

IdentifierTypeStateIssuer
228979000OtherVAMAGELLAN
567827OtherVAMAMSI
5774587OtherVAAETNA
1033138227MedicaidVA
034810OtherVAVALUE OPTIONS
118556OtherVAANTHEM
118556OtherVAHEALTHKEEPERS
081419OtherVASENTARA
2130368OtherCIGNA
413584OtherVAMHN

Other names 1

  • Susan C Nicholson PhD, LCSW dba Thimble Shoals Counseling & Therapy Ce Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040430000592 VA Part B Supplier - Clinic/Group Practice 7113914060 Receives reassigned benefits from 1 practitioner
Practice locations: Newport News, VA; Williamsburg, VA

National Provider Directory

National Provider Directory

Locations

703 Thimble Shoals Blvd
Ste D-2
Newport News, VA 23606
Phone (757) 873-3401

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1033138227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 WOODBURNE LN",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236028363",
            "telephone_number": "757-869-2361",
            "fax_number": "757-223-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 THIMBLE SHOALS BLVD",
            "address_2": "A3",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236062576",
            "telephone_number": "757-873-3401",
            "fax_number": "757-223-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIMBLE SHOALS COUNSELING & THERAPY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "757-869-2361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904003048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "228979000",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "567827",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5774587",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033138227",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "034810",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "118556",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHKEEPERS",
            "identifier": "118556",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA",
            "identifier": "081419",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2130368",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "413584",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan C Nicholson PhD, LCSW dba Thimble Shoals Counseling & Therapy Ce",
            "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 Jun 25, 2008; 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.