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Organization
WESTERN TIDEWATER COMMUNITY MENTAL
Active
Organization
WESTERN TIDEWATER COMMUNITY MENTAL
Active
Other names
Western Tidewater Community Services Board
Organization subpart
No
Provider details
NPI number
Authorized official
MARION YOUNG (REIMBURSEMENT SUPERVISOR)
(757) 687-9087
Entity
Organization
Contact information
Practice address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-2586
Mailing address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-2586
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
171WH0202X
Home Modifications Contractor
—
—
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
—
—
251B00000X
Case Management Agency
084-16-001
VA
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
333300000X
Emergency Response System Companies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945310
—
VA
05
—
1689615296
—
VA
01
—
270369
ANTHEM GROUP NUMBER
VA
Enumeration date
06/08/2006
Last updated
01/23/2026
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