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General NPI Number Information
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NPI Number | 1538869078
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Entity Type | Organization
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Legal Business Name | OPTIMUM FAMILY TREATMENT SERVICES
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 900 GRANBY ST STE 140
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City | NORFOLK
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State | VA
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Zip | 23510-2534
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Country | US
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Telephone | 757-756-5208
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Fax | 757-524-4353
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Provider Business Mailing Address
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Address Line | 900 GRANBY ST STE 140
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City | NORFOLK
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State | VA
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Zip | 23510-2534
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Country | US
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Telephone | 757-831-1644
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Fax | 757-524-4353
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Authorized Official
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Title or Position | CEO
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Name | MR. WALTER THOMAS JR.
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Credential | M.ED, QMHP-C/A
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Telephone | 757-831-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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