NPIMap

Organization Active NPI

Tiderwater Youth Service Commission

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Portsmouth, VA
National Provider Identifier
1215165451
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
TIDERWATER YOUTH SERVICE COMMISSION
Practice address
2404 Airline Blvd
Portsmouth, VA 23701-2912
Phone
(757) 488-9382
NPI assigned
Jun 25, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

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

Authorized official

Name
Mrs. Karis Holder, LPC
Title
Counselor Coordinator
Phone
(757) 488-9382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X VA Primary

Addresses

Primary practice location

2404 Airline Blvd
Portsmouth, VA 23701-2912

Mailing address

2404 Airline Blvd
Portsmouth, VA 23701-2912
Phone (757) 488-9382

National Provider Directory

National Provider Directory

Locations

2404 Airline Blvd
Portsmouth, VA 23701
Phone (757) 488-9161

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1215165451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012912",
            "telephone_number": "757-488-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012912",
            "telephone_number": "757-488-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDERWATER YOUTH SERVICE COMMISSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-25",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "KARIS",
        "authorized_official_title_or_position": "COUNSELOR COORDINATOR",
        "authorized_official_telephone_number": "757-488-9382",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; 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.