=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700431624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHLICHTER PSYCHOTHERAPY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2019
-----------------------------------------------------
Last Update Date | 10/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E PLUME ST STE 205
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-828-1640
-----------------------------------------------------
Fax | 757-210-3905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2546
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23450-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-340-3489
-----------------------------------------------------
Fax | 757-340-4278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JEFF SCHLICHTER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 757-828-1640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TP2701X
-----------------------------------------------------
Taxonomy Name | Group Psychotherapy Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------