Western Tidewater Community Mental

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WESTERN TIDEWATER COMMUNITY MENTAL

Doing business as

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

Jun 8, 2006

Last updated

Jan 23, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marion Young

Title

Reimbursement Supervisor

Phone

(757) 687-9087

Specialties & licenses 13

Addresses

Other names 1

• Western Tidewater Community Services Board Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 132

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.

• Karen Elizabeth Bailey, LPC

  • Professional Counselor
  • Smithfield, VA
  • NPI 1912499591
  Medicare reassignment Care Compare group NPD
• Cassandra Bradford, LPC

  • Professional Counselor
  • Suffolk, VA
  • NPI 1891477956
  Medicare reassignment Care Compare group NPD
• Kyrah M Coone, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Suffolk, VA
  • NPI 1124877469
  Medicare reassignment Care Compare group NPD
• Christina Marie Davis, LPC

  • Professional Counselor
  • Suffolk, VA
  • NPI 1023835071
  Medicare reassignment Care Compare group NPD
• Katrina Michele Faison-Crew, LPC

  • Professional Counselor
  • Franklin, VA
  • NPI 1598567604
  Medicare reassignment Care Compare group NPD
• Tiffany Fox, Fox

  • Clinical Social Worker
  • Suffolk, VA
  • NPI 1255209367
  Medicare reassignment Care Compare group NPD
• Shavaughn Lee Gordon Meyer, LCSW

  • Clinical Social Worker
  • Smithfield, VA
  • NPI 1306665344
  Medicare reassignment Care Compare group NPD
• Natalie Kay Horne, LMSW

  • Clinical Social Worker
  • Suffolk, VA
  • NPI 1518684679
  Medicare reassignment Care Compare group NPD
• Blair Labudovich

  • Professional Counselor
  • Suffolk, VA
  • NPI 1679211635
  Medicare reassignment Care Compare group NPD
• Samantha Rhiannon Leto

  • Clinical Social Worker
  • Suffolk, VA
  • NPI 1205356623
  Medicare reassignment Care Compare group NPD
• Towanna Morgan, LPC

  • Professional Counselor
  • Virginia Beach, VA
  • NPI 1336710466
  Medicare reassignment Care Compare group NPD
• Bridget Marnien Richardson, MA

  • Mental Health Counselor
  • Suffolk, VA
  • NPI 1164254843
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769126400000",
    "number": "1689615296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7025 HARBOUR VIEW BLVD STE 119",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352762",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7025 HARBOUR VIEW BLVD STE 119",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352762",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Commercial Ln",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348148",
            "country_code": "US",
            "telephone_number": "757-942-1069",
            "fax_number": "757-925-2213",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "641 Adkins Cir",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234343301",
            "country_code": "US",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Suburban Dr",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234342625",
            "country_code": "US",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 E 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "VA",
            "postal_code": "238511506",
            "country_code": "US",
            "telephone_number": "757-562-2208",
            "fax_number": "757-925-2296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "135 S Saratoga St",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234345322",
            "country_code": "US",
            "telephone_number": "757-935-5160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5268 Godwin Blvd",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348114",
            "country_code": "US",
            "telephone_number": "757-266-7131",
            "fax_number": "757-255-7128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "805 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234344068",
            "country_code": "US",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1428 Big Bethel Rd",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236661409",
            "country_code": "US",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1913 S Church St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "VA",
            "postal_code": "234301852",
            "country_code": "US",
            "telephone_number": "757-357-7458",
            "fax_number": "757-356-1808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16022 Everets Rd",
            "address_purpose": "LOCATION",
            "city": "Windsor",
            "state": "VA",
            "postal_code": "234876054",
            "country_code": "US",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-2586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WESTERN TIDEWATER COMMUNITY MENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MARION",
        "authorized_official_title_or_position": "REIMBURSEMENT SUPERVISOR",
        "authorized_official_telephone_number": "757-687-9087"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171WH0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor, Home Modifications",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225CA2400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Counselor, Assistive Technology Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "VA",
            "license": "084-16-001",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333300000X",
            "taxonomy_group": "",
            "desc": "Emergency Response System Companies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Tidewater Community Services Board",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carl Frank Wentzel III, M.D.
• Isabella Wessel
• Danielle C West, OTR/L, MOT
• Kara Anderson West
• 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

• Mental Health Clinic/Center (Including Community Mental Health Center) in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.