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General NPI Number Information
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NPI Number | 1467805671
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Entity Type | Organization
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Legal Business Name | EDWARD GUYTON, LCSW
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 425 W 20TH ST SUITE 5
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City | NORFOLK
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State | VA
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Zip | 23517-2128
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Country | US
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Telephone | 757-286-0264
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Fax | 757-440-5655
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Provider Business Mailing Address
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Address Line | 1341 SURREY CRES
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City | NORFOLK
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State | VA
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Zip | 23508-1130
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Country | US
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Telephone | 757-286-0264
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Fax | 757-440-5655
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD PAUL GUYTON
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Credential | L.C.S.W.
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Telephone | 757-286-0264
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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 | 0904006140
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License Number State | VA
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