Organization
PENINSULA PEDIATRIC PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE B TRICE MD (PRESIDENT)
(757) 593-6792
Entity
Organization
Contact information
Practice address
12350 JEFFERSON AVE, SUITE 190, NEWPORT NEWS, VA 23602-6951
(757) 881-9444
Mailing address
12350 JEFFERSON AVE, SUITE 190, NEWPORT NEWS, VA 23602-6951
(757) 881-9444
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
0101230611
VA
1041C0700X
Clinical Social Worker
05092005
VA
Other
Enumeration date
11/14/2006
Last updated
06/07/2008
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