=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235992140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WINTER GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2024
-----------------------------------------------------
Last Update Date | 02/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1269 TWEEDBROOK PL
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-504-9507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1269 TWEEDBROOK PL
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-504-9507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LESLIE CHURN WILLIAMS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 757-504-9507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------