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General NPI Number Information
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NPI Number | 1841814639
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Entity Type | Organization
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Legal Business Name | THE CHILDREN AND ADULT COUNSELING CENTER LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 930 MAJESTIC AVE STE 100
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City | NORFOLK
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State | VA
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Zip | 23504-4055
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Country | US
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Telephone | 757-627-1099
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Fax | 757-640-0954
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Provider Business Mailing Address
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Address Line | 930 MAJESTIC AVE STE 100
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City | NORFOLK
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State | VA
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Zip | 23504-4055
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Country | US
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Telephone | 757-627-1099
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Fax | 757-640-0954
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Authorized Official
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Title or Position | OWNER/PROVIDER AUTHORIZED OFFICIAL
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Name | PAUL WALKER JR.
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Credential | PH.D.
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Telephone | 757-627-1099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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