# PENINSULA PEDIATRIC PSYCHIATRY

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

## Provider details

- **NPI number:** 1982776902
- **Authorized official:** JULIE B TRICE MD (PRESIDENT)
- **Authorized official phone:** (757) 593-6792

## Contact information

- **Practice address:** 12350 JEFFERSON AVE, SUITE 190, NEWPORT NEWS, VA 23602-6951
- **Practice address phone:** (757) 881-9444
- **Mailing address:** 12350 JEFFERSON AVE, SUITE 190, NEWPORT NEWS, VA 23602-6951
- **Mailing address phone:** (757) 881-9444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 0101230611 | VA | Yes |
| 1041C0700X | Clinical Social Worker | 05092005 | VA | — |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 06/07/2008