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General NPI Number Information
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NPI Number | 1417679739
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Entity Type | Individual
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Provider Name | KASYIDA THOMAS LPC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 500 E MAIN ST
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City | NORFOLK
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State | VA
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Zip | 23510-2205
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Country | US
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Telephone | 757-524-2458
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 GENEVA AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23323-4800
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Country | US
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Telephone | 516-850-6884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701011799
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License Number State | VA
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