Healthcare Provider Details

I. General information

NPI: 1568122208
Provider Name (Legal Business Name): SEASHORE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5267 GREENWICH RD
VIRGINIA BEACH VA
23462-6028
US

IV. Provider business mailing address

1245 CEDAR RD STE G
CHESAPEAKE VA
23322-7141
US

V. Phone/Fax

Practice location:
  • Phone: 757-204-1914
  • Fax:
Mailing address:
  • Phone: 757-284-9182
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON WALKER
Title or Position: OWNER
Credential: LPC, NCC
Phone: 757-204-1914