| Independence Child Therapy Services Llc | |
|
4807a Lauderdale Ave Virginia Beach VA 23455-1364 | |
| (757) 460-2057 | |
| (757) 963-9020 |
| Full Name | Independence Child Therapy Services Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4807a Lauderdale Ave, Virginia Beach, Virginia |
| Authorized Official Name and Position | Linda Bourdon (DIRECTOR) |
| Authorized Official Contact | 7574602057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Child Therapy Services Llc Po Box 55145 Virginia Beach VA 23471-5145 Ph: (757) 460-2057 | Independence Child Therapy Services Llc 4807a Lauderdale Ave Virginia Beach VA 23455-1364 Ph: (757) 460-2057 |
| NPI Number | 1417232802 |
|---|---|
| Provider Enumeration Date | 10/17/2011 |
| Last Update Date | 10/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417232802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810004468 (Virginia) | Primary |
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