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General NPI Number Information
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NPI Number | 1497352454
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Entity Type | Organization
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Legal Business Name | GRATITUDE INDIVIDUAL & FAMILY THERAPY SERVICES
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 900 COMMONWEALTH PLACE PMB 2089
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-632-7848
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64783
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City | VIRGINIA BEACH
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State | VA
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Zip | 23467-4783
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Country | US
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Telephone | 737-632-7848
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LATOYA COTMAN
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Credential | LPC
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Telephone | 804-218-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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