NPIMap

Organization Active NPI

Tidewater Recovery, PLC

  • Clinical Social Worker
  • Urbanna, VA
National Provider Identifier
1396001855
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904005105 Issued in VA
Legal business name
TIDEWATER RECOVERY, PLC
Practice address
55 Cross Street
Urbanna, VA 23175
Phone
(804) 758-4242
Fax
(615) 704-7447
NPI assigned
Apr 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

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

Authorized official

Name
Ms. Susan G Hallett, LCSWNPI 1205910460
Title
Owner/Therapist
Phone
(804) 758-4242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 0904005105 VA Primary

Addresses

Primary practice location

55 Cross Street
Urbanna, VA 23175

Mailing address

PO Box 1042
55 Cross Street
Urbanna, VA 23175-1042
Phone (804) 758-4242

Other identifiers 1

IdentifierTypeStateIssuer
1205910460OtherVANPI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1333929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1396001855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1042",
            "address_2": "55 CROSS STREET",
            "city": "URBANNA",
            "state": "VA",
            "postal_code": "231751042",
            "telephone_number": "804-758-4242",
            "fax_number": "615-704-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 CROSS STREET",
            "city": "URBANNA",
            "state": "VA",
            "postal_code": "23175",
            "telephone_number": "804-758-4242",
            "fax_number": "615-704-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER RECOVERY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-09",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "HALLETT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "804-758-4242",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205910460",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbanna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; 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.