Healthcare Provider Details

I. General information

NPI: 1730987827
Provider Name (Legal Business Name): ROSE WATER PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2697 INTERNATIONAL PARKWAY I SUITE 103
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

3419 VIRGINIA BEACH BLVD # 5184
VIRGINIA BEACH VA
23452-4419
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-3118
  • Fax:
Mailing address:
  • Phone: 757-937-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VANESSA K BRUCE
Title or Position: OWNER
Credential: LCSW
Phone: 757-937-3118