Healthcare Provider Details

I. General information

NPI: 1417679739
Provider Name (Legal Business Name): KASYIDA THOMAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KASYIDA BRIGGINS

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST
NORFOLK VA
23510-2205
US

IV. Provider business mailing address

1016 GENEVA AVE
CHESAPEAKE VA
23323-4800
US

V. Phone/Fax

Practice location:
  • Phone: 757-524-2458
  • Fax:
Mailing address:
  • Phone: 516-850-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011799
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: