MEDICARE: CHARLENE J WIMBISH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689151524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE J WIMBISH

Provider Business Mailing Address
First Line	:	1499 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2827
Country	:	US
Telephone Number	:	757-452-4356
Fax Number	:	757-512-6251

Provider Business Practice Location Address
First Line	:	1499 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2827
Country	:	US
Telephone Number	:	757-452-4356
Fax Number	:	757-512-6251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	08/25/2025

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