MEDICARE: NEW SEASON CLINICAL SERVICES, LLC

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
1	251S00000X	Community/Behavioral Health Agency	1139	VA

General Provider Information

NPI Number	:	1487819850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SEASON CLINICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	809 MAIN ST
Second Line	:	SUITE 100
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1090
Country	:	US
Telephone Number	:	757-592-2727
Fax Number	:	757-595-2776

Provider Business Practice Location Address
First Line	:	809 MAIN ST
Second Line	:	SUITE 100
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1090
Country	:	US
Telephone Number	:	757-592-2727
Fax Number	:	757-595-2776

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DELORES THOMAS
Credential	:
Telephone Number	:	757-595-2727

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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