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General NPI Number Information
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NPI Number | 1033138227
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Entity Type | Organization
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Legal Business Name | THIMBLE SHOALS COUNSELING & THERAPY CENTER PC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 703 THIMBLE SHOALS BLVD A3
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2576
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Country | US
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Telephone | 757-873-3401
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Fax | 757-223-1165
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Provider Business Mailing Address
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Address Line | 203 WOODBURNE LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-8363
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Country | US
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Telephone | 757-869-2361
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Fax | 757-223-1165
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. SUSAN C NICHOLSON
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Credential | CSW
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Telephone | 757-869-2361
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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 | 0904003048
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License Number State | VA
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