Healthcare Provider Details

I. General information

NPI: 1689151524
Provider Name (Legal Business Name): CHARLENE J WIMBISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 TIDEWATER DR
NORFOLK VA
23504-2827
US

IV. Provider business mailing address

1499 TIDEWATER DR
NORFOLK VA
23504-2827
US

V. Phone/Fax

Practice location:
  • Phone: 757-452-4356
  • Fax: 757-512-6251
Mailing address:
  • Phone: 757-452-4356
  • Fax: 757-512-6251

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:
Title or Position:
Credential:
Phone: