NPIMap

Organization Active NPI

Deep Connections Counseling LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norfolk, VA
National Provider Identifier
1699244996
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
DEEP CONNECTIONS COUNSELING LLC
Practice address
129 W Virginia Beach Blvd
Norfolk, VA 23510-2030
Phone
(757) 319-5416
NPI assigned
Nov 15, 2018
Last updated
Nov 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

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

Authorized official

Name
Kinga Gudor, LCSW, PHDNPI 1508187881
Title
Psychotherapist
Phone
(757) 319-5410

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

129 W Virginia Beach Blvd
Norfolk, VA 23510-2030

Mailing address

1146 Rockbridge Ave
Norfolk, VA 23508-1418
Phone (757) 319-5416

Other practice location 1

2224 S Croatan Hwy
Nags Head, NC 27959-8813
Phone (757) 319-5416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190509002018 NC Part B Supplier - Clinic/Group Practice 4082957295 Receives reassigned benefits from 2 practitioners
Practice locations: Tarboro, NC
O20190509002495 VA Part B Supplier - Clinic/Group Practice 4082957295 Receives reassigned benefits from 5 practitioners
Practice locations: Norfolk, VA

National Provider Directory

National Provider Directory

Locations

129 W Virginia Beach Blvd
Norfolk, VA 23510
Phone (757) 319-5416

129 W Virginia Beach Blvd
Ste 200E
Norfolk, VA 23510
Phone (757) 704-5558

Practitioners & affiliated clinicians

Practitioners 10

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": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1699244996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1146 ROCKBRIDGE AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235081418",
            "telephone_number": "757-319-5416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W VIRGINIA BEACH BLVD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102030",
            "telephone_number": "757-319-5416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2224 S Croatan Hwy",
            "address_purpose": "LOCATION",
            "city": "Nags Head",
            "state": "NC",
            "postal_code": "279598813",
            "country_code": "US",
            "telephone_number": "757-319-5416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DEEP CONNECTIONS COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "GUDOR",
        "authorized_official_first_name": "KINGA",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "757-319-5410",
        "authorized_official_credential": "LCSW, PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; 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.