Provider Demographics
NPI:1538869078
Name:OPTIMUM FAMILY TREATMENT SERVICES
Entity type:Organization
Organization Name:OPTIMUM FAMILY TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MED, QMHP-C/A
Authorized Official - Phone:757-831-1644
Mailing Address - Street 1:900 GRANBY ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2534
Mailing Address - Country:US
Mailing Address - Phone:757-831-1644
Mailing Address - Fax:757-524-4353
Practice Address - Street 1:900 GRANBY ST STE 140
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2534
Practice Address - Country:US
Practice Address - Phone:757-756-5208
Practice Address - Fax:757-524-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health