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General NPI Number Information
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NPI Number | 1861942237
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Entity Type | Organization
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Legal Business Name | SUBSTANCE ABUSE PROFESSIONALS OF TIDEWATER
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 2940 N LYNNHAVEN RD STE 130
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6949
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Country | US
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Telephone | 757-636-9187
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Fax | 888-785-9387
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Provider Business Mailing Address
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Address Line | 2940 N LYNNHAVEN RD STE 130
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6949
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Country | US
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Telephone | 757-636-9187
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Fax | 888-785-9387
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MARGARET RAY LIDSTROM
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Credential | LCSW
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Telephone | 757-636-9187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904000638
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License Number State | VA
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