Organization
PURPLE SERVICE ANNOUNCEMENT
Active
Organization
PURPLE SERVICE ANNOUNCEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANIKIA WASHINGTON (EXECUTIVE DIRECTOR)
(910) 703-2848
Entity
Organization
Contact information
Practice address
2313 RED TIDE RD UNIT 2, VIRGINIA BCH, VA 23451-1203
(910) 703-2848
Mailing address
2313 RED TIDE RD UNIT 1, VIRGINIA BEACH, VA 23451-1203
(910) 703-2848
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/02/2025
Last updated
07/02/2025
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