Healthcare Provider Details

I. General information

NPI: 1932954229
Provider Name (Legal Business Name): WIDENING THE WINDOW PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 HARDING DRIVE
CHESAPEAKE VA
23321
US

IV. Provider business mailing address

7330 STAPLES MILL RD PMB #244
HENRICO VA
23228
US

V. Phone/Fax

Practice location:
  • Phone: 757-636-4800
  • Fax:
Mailing address:
  • Phone: 757-636-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CASSIDY ROBINSON VAN DE GRAAF
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 757-636-4800