Substance Abuse Professionals of Tidewater

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904000638 Issued in VA

Legal business name

SUBSTANCE ABUSE PROFESSIONALS OF TIDEWATER

Practice address

2940 N Lynnhaven Rd Ste 130
Virginia Beach, VA 23452-6949

Phone

(757) 636-9187

Fax

(888) 785-9387

NPI assigned

Oct 10, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Margaret Ray Lidstrom, LCSW

Title

Manager

Phone

(757) 636-9187

Specialties & licenses 1

Addresses

Other names 1

• Peggy Lidstrom LCSW Doing business as

Locations

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1861942237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 N LYNNHAVEN RD STE 130",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526949",
            "telephone_number": "757-636-9187",
            "fax_number": "888-785-9387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 N LYNNHAVEN RD STE 130",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526949",
            "telephone_number": "757-636-9187",
            "fax_number": "888-785-9387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBSTANCE ABUSE PROFESSIONALS OF TIDEWATER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "LIDSTROM",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "757-636-9187",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904000638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peggy Lidstrom LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jena Sturm, M.ED., CF-SLP
• Cynthia C Su, MD
• Maria Gabriela Suarez Lopez, MD
• Oscar Arturo Suarez, M.D.
• Sublime Mind, PLLC
• Sugar Plum Bakery
• Thomas Andrew Sugden, PSYD
• Amorsolo Laja Suguitan Jr., MD, MSC, PHD
• Raymond Suhr, IDC
• Feng Sui, L.AC.

• Clinical Social Worker in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.