Healthcare Provider Details

I. General information

NPI: 1992718308
Provider Name (Legal Business Name): CATHY A TIRRELL LCP, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL DR SUITE A
HAMPTON VA
23666-1769
US

IV. Provider business mailing address

2501 WASHINGTON AVE 1ST FLOOR
NEWPORT NEWS VA
23607-4327
US

V. Phone/Fax

Practice location:
  • Phone: 757-788-0600
  • Fax: 757-788-0932
Mailing address:
  • Phone: 757-245-0217
  • Fax: 757-245-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003664
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: