MEDICARE: AVISO CONSULTING & PSYCHOTHERAPY SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904002589	VA

General Provider Information

NPI Number	:	1023458684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVISO CONSULTING & PSYCHOTHERAPY SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	999 WATERSIDE DR
Second Line	:	STE 2525
City	:	NORFOLK
State	:	VA
Zip	:	23510-3300
Country	:	US
Telephone Number	:	757-777-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 WATERSIDE DR
Second Line	:	STE 2525
City	:	NORFOLK
State	:	VA
Zip	:	23510-3300
Country	:	US
Telephone Number	:	757-777-3710
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. VICKIE V. HAWKINS
Credential	:	LCSW
Telephone Number	:	757-777-3710

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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