Organization
TIDEWATER THERAPEUTIC AFTERSCHOOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PRINCETTA D WOOTEN (PRESIDENT)
(757) 592-7584
Entity
Organization
Contact information
Practice address
12 SALTERS CREEK RD, HAMPTON, VA 23661-2453
(757) 380-0194
Mailing address
12 SALTERS CREEK RD, HAMPTON, VA 23661-2453
(757) 380-0194
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1742
VA
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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