| Tidewater Recovery, Plc | |
|
55 Cross Street Urbanna VA 23175 | |
| (804) 758-4242 | |
| (615) 704-7447 |
| Full Name | Tidewater Recovery, Plc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 55 Cross Street, Urbanna, Virginia |
| Authorized Official Name and Position | Susan G Hallett (OWNER/THERAPIST) |
| Authorized Official Contact | 8047584242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Recovery, Plc Po Box 1042 55 Cross Street Urbanna VA 23175-1042 Ph: (804) 758-4242 | Tidewater Recovery, Plc 55 Cross Street Urbanna VA 23175 Ph: (804) 758-4242 |
| NPI Number | 1396001855 |
|---|---|
| Provider Enumeration Date | 04/09/2012 |
| Last Update Date | 04/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396001855 | NPI | - | NPPES |
| 1205910460 | Other | VA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904005105 (Virginia) | Primary |
Bay Aging Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5306 Old Virginia Street, Urbanna, VA 23175 Phone: 804-758-2386 |