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General NPI Number Information
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NPI Number | 1861925364
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Entity Type | Organization
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Legal Business Name | WALDRON AND ASSOCIATES LLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 4663 HAYGOOD RD BLDG 2 SUITE 216
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5442
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Country | US
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Telephone | 804-641-5176
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Fax |
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Provider Business Mailing Address
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Address Line | 4663 HAYGOOD RD BLDG 2 SUITE 216
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5442
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Country | US
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Telephone | 804-641-5176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA WALDRON CHILDRESS
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Credential | LPC
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Telephone | 804-641-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701005620
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License Number State | VA
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