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General NPI Number Information
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NPI Number | 1023103124
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Entity Type | Organization
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Legal Business Name | COMMUNITY PSYCHOLOGICAL RESOURCES
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 249 W YORK ST
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City | NORFOLK
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State | VA
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Zip | 23510-1520
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Country | US
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Telephone | 757-622-6794
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Fax | 757-626-1509
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Provider Business Mailing Address
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Address Line | 249 W YORK ST
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City | NORFOLK
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State | VA
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Zip | 23510-1520
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Country | US
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Telephone | 757-622-6794
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Fax | 757-626-1509
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. CARA LEE MATHEWS
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Credential | LCSW
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Telephone | 757-622-6794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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