Organization
TIDERWATER YOUTH SERVICE COMMISSION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KARIS HOLDER LPC (COUNSELOR COORDINATOR)
(757) 488-9382
Entity
Organization
Contact information
Practice address
2404 AIRLINE BLVD, PORTSMOUTH, VA 23701-2912
(757) 488-9382
Mailing address
2404 AIRLINE BLVD, PORTSMOUTH, VA 23701-2912
(757) 488-9382
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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