Healthcare Provider Details

I. General information

NPI: 1376813410
Provider Name (Legal Business Name): OYSTER POINT COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD OYSTER POINT RD SUITE 250
NEWPORT NEWS VA
23602-7121
US

IV. Provider business mailing address

PO BOX 2057
YORKTOWN VA
23692
US

V. Phone/Fax

Practice location:
  • Phone: 757-240-1067
  • Fax: 757-659-0128
Mailing address:
  • Phone: 757-240-1067
  • Fax: 757-659-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001186
License Number StateVA

VIII. Authorized Official

Name: MR. TIMOTHY WILLIAM LATSKO
Title or Position: DIRECTOR
Credential: LMFT, LPC
Phone: 757-240-1067