MEDICARE: NEW THERAPIST, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720868425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW THERAPIST, LLC

Provider Business Mailing Address
First Line	:	3853 COLONIAL PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3853 COLONIAL PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2201
Country	:	US
Telephone Number	:	757-285-1775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAILAH WASHINGTON
Credential	:	LPC
Telephone Number	:	757-285-1775

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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