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General NPI Number Information
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NPI Number | 1861265274
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Entity Type | Organization
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Legal Business Name | WINGATE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 13208 PARTING CREEK ROAD
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City | EXMORE
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State | VA
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Zip | 23350-2335
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Country | US
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Telephone | 757-802-4552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1021
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City | EXMORE
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State | VA
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Zip | 23350-1021
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Country | US
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Telephone | 757-802-4552
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Fax | 757-384-4158
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Authorized Official
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Title or Position | PSYCHOLOGIST / OWNER
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Name | DR. JESSE ALEXANDER WINGATE
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Credential | PH.D.
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Telephone | 757-802-4552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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