Western Tidewater Community Services Board
Organization Active NPI Primary Care Clinic/Center · Suffolk, VA
NPI 1245082270 · NPPES record last updated Apr 3, 2024
Key facts
- NPI
- 1245082270
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- WESTERN TIDEWATER COMMUNITY SERVICES BOARD
- Practice address
- 7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762 - Phone
- (757) 966-2805
- Fax
- (757) 673-2586
- NPI assigned
- Apr 3, 2024
- Organization subpart
- No
Authorized official
- Name
- Demetrios Nicholas Peratsakis, PD, MS, LPC
- Title
- Executive Director
- Phone
- (757) 377-2397
Corporate family (same tax ID) 7
National Provider Directory
- Tax ID family
- Western Tidewater Community Services Board
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762
Mailing address
7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762
Phone (757) 966-2805
Other providers in Suffolk, VA
- Danielle C West
- Kara Anderson West
- Western Tidewater Community Mental
- Western Tidewater Community Mental
- Western Tidewater Community Services Board
- Western Tidewater Community Services Board
- Western Tidewater Community Services Board
- Western Tidewater Community Services Board
- Western Tidewater Community Services Board
- Western Tidewater Free Clinic Inc
All providers in Suffolk, VA · Primary Care Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.