=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437021813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST BEACH PSYCHOLOGICAL SERVICES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4490 PLEASANT AVE UNIT B
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23518-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-796-5851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4490 PLEASANT AVE UNIT B
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23518-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-796-5851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ASHLEY KANE
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 757-796-5851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------