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NPI Code Detail

MEDICARE: DR. TREVOR JOHN ESSIQUE PSY.D.

MEDICARE: DR. TREVOR JOHN ESSIQUE PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810005671VA

General Provider Information

NPI Number : 1225520075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TREVOR JOHN ESSIQUE PSY.D.
Provider Business Mailing Address
First Line : 641 CARRIAGE HILL RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-6518
Country : US
Telephone Number : 757-263-2700
Fax Number :
Provider Business Practice Location Address
First Line : 641 CARRIAGE HILL RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-6518
Country : US
Telephone Number : 757-263-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2018
Last Update Date : 06/06/2018

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