NPIMap

Organization Active NPI

Western Tidewater Community Services Board

  • Adolescent and Children Mental Health Clinic/Center
  • Suffolk, VA
National Provider Identifier
1164416533
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
0904002622 Issued in VA
Legal business name
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Practice address
5268 Godwin Blvd
Suffolk, VA 23434-8135
Phone
(757) 255-7100
NPI assigned
Aug 31, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Emily Bowe Hughes, LCSW
Title
Clinician
Phone
(757) 255-7113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 0904002622 VA Primary

Addresses

Primary practice location

5268 Godwin Blvd
Suffolk, VA 23434-8135

Mailing address

5268 Godwin Blvd
Suffolk, VA 23434-8135
Phone (757) 255-7100

National Provider Directory

National Provider Directory
Tax ID family
Western Tidewater Community Services Board8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164416533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5268 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348135",
            "telephone_number": "757-255-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5268 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348135",
            "telephone_number": "757-255-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN TIDEWATER COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "BOWE",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "757-255-7113",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": "0904002622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.