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General NPI Number Information
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NPI Number | 1629548243
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Entity Type | Organization
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Legal Business Name | BAY PSYCHIATRIC, INC.
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 923 FIRST COLONIAL RD STE 1821
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3182
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Country | US
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Telephone | 757-425-5010
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Fax | 757-425-5011
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Provider Business Mailing Address
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Address Line | 923 FIRST COLONIAL RD STE 1821
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3182
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Country | US
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Telephone | 757-425-5010
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Fax | 757-425-5011
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARLENE M. JURON
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Credential | LCSW
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Telephone | 941-302-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701002059
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009017
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904004044
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000200
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101262710
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101262710
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0102203811
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License Number State | VA
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