Healthcare Provider Details

I. General information

NPI: 1114694098
Provider Name (Legal Business Name): MERMAID COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 W BUTE ST
NORFOLK VA
23510-1403
US

IV. Provider business mailing address

1718 LAFAYETTE BLVD
NORFOLK VA
23509-1116
US

V. Phone/Fax

Practice location:
  • Phone: 757-715-2083
  • Fax:
Mailing address:
  • Phone: 757-715-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRYSTIN RIZZO
Title or Position: OWNER
Credential:
Phone: 757-715-2083