Western Tidewater Community Mental
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Suffolk, VA
NPI 1689615296 · NPPES record last updated Jan 23, 2026
Key facts
- NPI
- 1689615296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- WESTERN TIDEWATER COMMUNITY MENTAL
- 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
- Organization subpart
- No
Authorized official
- Name
- Marion Young
- Title
- Reimbursement Supervisor
- Phone
- (757) 687-9087
Practitioners 132
-
Cassandra Bradford, LPC
-
Kyrah M Coone, PMHNP
-
Natalie Kay Horne, LMSW
-
Towanna Morgan, LPC
-
Lisa A Rivera, NP
-
Richard Turner, LPC
-
Michelle Wiggins, LPC
-
Margot Veronica Wilson, NURSE PRACTITIONER
-
Telena Sheree Pollard, PMHNP-BC
-
Damara Beckett, LPC, CSAC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040823001494 | VA | Part B Supplier - Clinic/Group Practice | 2961476114 |
Receives reassigned benefits from 77 practitioners Practice locations: Suffolk, VA; Smithfield, VA; Franklin, VA |
National Provider Directory
Locations
200 E 2nd Ave
Franklin, VA 23851
Phone (757) 562-2208
1913 S Church St
Ste 2
Smithfield, VA 23430
Phone (757) 357-7458
1801 S Church St
Ste 6
Smithfield, VA 23430
7025 Harbour View Blvd
Ste 119
Suffolk, VA 23435
Phone (757) 670-7471
157 N Main St
Ste D
Suffolk, VA 23434
Phone (757) 925-2484
1000 Commercial Ln
Suffolk, VA 23434
Phone (757) 925-2484
135 S Saratoga St
Suffolk, VA 23434
Phone (757) 925-1981
16022 Everets Rd
Windsor, VA 23487
Phone (757) 255-4616
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse |
163WC0400X | |||
| Home Modifications Contractor |
171WH0202X | |||
| Assistive Technology Practitioner Rehabilitation Counselor |
225CA2400X | |||
| Case Management Agency | 251B00000X | 084-16-001 | VA | |
| Developmentally Disabled Services Day Training Agency | 251C00000X | |||
| Nursing Care Agency | 251J00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes | ||
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | |||
| Psychiatric Residential Treatment Facility | 323P00000X | |||
| Emergency Response System Companies | 333300000X | |||
| Non-emergency Medical Transport (VAN) | 343900000X | VA |
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 practice location 1
1000 Commercial Ln
Suffolk, VA 23434-8148
Phone (757) 942-1069
Other practice location 2
641 Adkins Cir
Suffolk, VA 23434-3301
Phone (757) 966-2805
Other practice location 3
130 Suburban Dr
Suffolk, VA 23434-2625
Phone (757) 966-2805
Other practice location 4
200 E 2nd Ave
Franklin, VA 23851-1506
Phone (757) 562-2208
Other practice location 5
135 S Saratoga St
Suffolk, VA 23434-5322
Phone (757) 935-5160
Other practice location 6
5268 Godwin Blvd
Suffolk, VA 23434-8114
Phone (757) 266-7131
Other practice location 7
805 Jefferson St
Suffolk, VA 23434-4068
Phone (757) 966-2805
Other practice location 8
1428 Big Bethel Rd
Hampton, VA 23666-1409
Phone (757) 966-2805
Other practice location 9
1913 S Church St Ste 2
Smithfield, VA 23430-1852
Phone (757) 357-7458
Other practice location 10
16022 Everets Rd
Windsor, VA 23487-6054
Phone (757) 966-2805
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 270369 | Other | VA | ANTHEM GROUP NUMBER |
| 004945310 | Medicaid | VA | |
| 1689615296 | Medicaid | VA |
Other names
- Western Tidewater Community Services Board
Other providers in Suffolk, VA
- Carl Frank Wentzel III
- Isabella Wessel
- Danielle C West
- 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
All providers in Suffolk, VA · Mental Health Clinic/Center (Including Community Mental Health 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 Jan 23, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.