Provider Demographics
NPI:1528087616
Name:ASSOCIATED COUNSELORS OF TIDEWATER
Entity type:Organization
Organization Name:ASSOCIATED COUNSELORS OF TIDEWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-490-6960
Mailing Address - Street 1:287 INDEPENDENCE BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2956
Mailing Address - Country:US
Mailing Address - Phone:757-490-6960
Mailing Address - Fax:757-490-6995
Practice Address - Street 1:287 INDEPENDENCE BLVD STE 219
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2956
Practice Address - Country:US
Practice Address - Phone:757-490-6960
Practice Address - Fax:757-490-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024541041C0700X
VA0717000866106H00000X
VA0701002379101YP2500X
VA0717000080106H00000X
VA07010001157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06076Medicare UPIN