NPIMap

Organization Active NPI

Tidewater Therapeutic Afterschool

  • Community/Behavioral Health Agency
  • Hampton, VA
National Provider Identifier
1881032183
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1742 Issued in VA
Legal business name
TIDEWATER THERAPEUTIC AFTERSCHOOL
Practice address
12 Salters Creek Rd
Hampton, VA 23661-2453
Phone
(757) 380-0194
NPI assigned
Jun 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Authorized official

Name
Ms. Princetta D Wooten
Title
President
Phone
(757) 592-7584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1742 VA Primary

Addresses

Primary practice location

12 Salters Creek Rd
Hampton, VA 23661-2453

Mailing address

12 Salters Creek Rd
Hampton, VA 23661-2453
Phone (757) 380-0194

National Provider Directory

National Provider Directory

Locations

12 Salters Creek Rd
Hampton, VA 23661
Phone (757) 380-0194

NPI Registry JSON

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1881032183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SALTERS CREEK RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236612453",
            "telephone_number": "757-380-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SALTERS CREEK RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236612453",
            "telephone_number": "757-380-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER THERAPEUTIC AFTERSCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "WOOTEN",
        "authorized_official_first_name": "PRINCETTA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-592-7584",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "1742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; 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.