Healthcare Provider Details

I. General information

NPI: 1285304055
Provider Name (Legal Business Name): MERIDIAN PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax: 757-460-7744
Mailing address:
  • Phone: 757-460-4655
  • Fax: 757-460-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSON MYERS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 757-460-4655