=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053101121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK PHILIP ALWINE LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 VILLAGE AVE STE 204
-----------------------------------------------------
City | YORKTOWN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23693-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-568-5904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 697 TECH CENTER PKWY APT 3420
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-1562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-288-3139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904018101
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------