Healthcare Provider Details

I. General information

NPI: 1437021813
Provider Name (Legal Business Name): EAST BEACH PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 PLEASANT AVE UNIT B
NORFOLK VA
23518-1821
US

IV. Provider business mailing address

4490 PLEASANT AVE UNIT B
NORFOLK VA
23518-1821
US

V. Phone/Fax

Practice location:
  • Phone: 757-796-5851
  • Fax:
Mailing address:
  • Phone: 757-796-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY KANE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSY.D.
Phone: 757-796-5851