Healthcare Provider Details

I. General information

NPI: 1548292782
Provider Name (Legal Business Name): CAROLYN FOSTER TIGHE ED.D,LMFT,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 MCMANUS BLVD BLDG 2 SUITE G
NEWPORT NEWS VA
23602-4402
US

IV. Provider business mailing address

12725 MCMANUS BLVD BLDG 2 SUITE G
NEWPORT NEWS VA
23602-4402
US

V. Phone/Fax

Practice location:
  • Phone: 757-874-1676
  • Fax: 757-874-2226
Mailing address:
  • Phone: 757-874-1676
  • Fax: 757-874-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000076
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: