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General NPI Number Information
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NPI Number | 1366956096
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGICAL SERVICES OF TIDEWATER, LLC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 2005 PLEASURE HOUSE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455
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Country | US
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Telephone | 757-301-2248
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Fax | 757-689-8378
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Provider Business Mailing Address
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Address Line | 2005 PLEASURE HOUSE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-2709
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Country | US
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Telephone | 757-301-2248
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Fax | 757-689-8378
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. JAMIE DUCHARME
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Credential | PHD
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Telephone | 757-301-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0810004265
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License Number State | VA
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