# TIDEWATER PSYCHOTHERAPY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700830742
- **Authorized official:** LOUISE FRIEDMAN LCSW (PRESIDENT, AUTHORIZAED OFFICAL)
- **Authorized official phone:** (757) 497-3670

## Contact information

- **Practice address:** 260 GRAYSON RD, SUITE 100, VIRGINIA BEACH, VA 23462-4345
- **Practice address phone:** (757) 497-3670
- **Practice address fax:** (757) 499-1947
- **Mailing address:** 260 GRAYSON RD, SUITE 100, VIRGINIA BEACH, VA 23462-4345
- **Mailing address phone:** (757) 497-3670
- **Mailing address fax:** (757) 499-1947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 204 | VA | — |
| 104100000X | Social Worker | 2006112732R | VA | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 08/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1700830742 | — | VA |