| Lakeside Psychological Center Pc | |
|
3076 Brickhouse Ct Virginia Beach VA 23452-6859 | |
| (757) 486-0909 | |
| (757) 340-7518 |
| Full Name | Lakeside Psychological Center Pc |
|---|---|
| Speciality | Psychologist |
| Location | 3076 Brickhouse Ct, Virginia Beach, Virginia |
| Authorized Official Name and Position | Theodore M Stevens (PRESIDENT, PSYCHOLOGIST) |
| Authorized Official Contact | 7574860909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Psychological Center Pc 3076 Brickhouse Ct Virginia Beach VA 23452-6859 Ph: (757) 486-0909 | Lakeside Psychological Center Pc 3076 Brickhouse Ct Virginia Beach VA 23452-6859 Ph: (757) 486-0909 |
| NPI Number | 1104044528 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 09/01/2010 |
| Medicare PECOS PAC ID | 8022076660 |
|---|---|
| Medicare Enrollment ID | O20041229000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104044528 | NPI | - | NPPES |
| 1790811040 | Other | VA | NPI |
| 1104044528 | Other | VA | CORPORATE NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 90801000970 (Virginia) | Primary |
| Provider Name | Theodore M Stevens |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790824381 PECOS PAC ID: 7911021043 Enrollment ID: I20160127001963 |
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