Active NPI
Terri Widen
- Counselor
- Norfolk, VA
National Provider Identifier
1114567666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0704011409
- Practice address
- 110 Maycox Ave Ste 3
Norfolk, VA 23505-3433 - Phone
- (757) 769-7040
- NPI assigned
- Jan 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0704011409 | VA | Primary |
Addresses
Primary practice location
110 Maycox Ave Ste 3
Norfolk, VA 23505-3433
Mailing address
5704 Fort Belvoir CT
Virginia Beach, VA 23464-8785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704011409 | VA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PBP Psychotherapy LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Norfolk, VA
- NPI 1346677820
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1114567666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5704 FORT BELVOIR CT",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234648785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MAYCOX AVE STE 3",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235053433",
"telephone_number": "757-769-7040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDEN",
"first_name": "TERRI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-13",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0704011409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.