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2006 Old Greenbrier Road Suite 12 Chesapeake VA 23320-2648 | |
| (757) 228-5635 | |
| (757) 233-0327 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2006 Old Greenbrier Road, Chesapeake, Virginia |
| Authorized Official Name and Position | James F Lassiter (OWNER) |
| Authorized Official Contact | 7572285635 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2006 Old Greenbrier Road Suite 12 Chesapeake VA 23320-2648 Ph: (757) 228-5635 | 2006 Old Greenbrier Road Suite 12 Chesapeake VA 23320-2648 Ph: (757) 228-5635 |
| NPI Number | 1083176796 |
|---|---|
| Provider Enumeration Date | 04/02/2019 |
| Last Update Date | 08/24/2023 |
| Certification Date | 08/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083176796 | NPI | - | NPPES |
| 1851352496 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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