Organization
WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIOS NICHOLAS PERATSAKIS PD, MS, LPC (EXECUTIVE DIRECTOR)
(757) 377-2397
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
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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