| Providence Psychological Services Inc | |
|
129 N Saratoga St Ste 1 Suffolk VA 23434-5255 | |
| (757) 539-5353 | |
| (757) 539-5399 |
| Full Name | Providence Psychological Services Inc |
|---|---|
| Speciality | Social Worker |
| Location | 129 N Saratoga St, Suffolk, Virginia |
| Authorized Official Name and Position | Kawanna Evette Ward (CEO) |
| Authorized Official Contact | 7575357839 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Psychological Services Inc 129 N Saratoga St Ste 1 Suffolk VA 23434-5255 Ph: (757) 539-5353 | Providence Psychological Services Inc 129 N Saratoga St Ste 1 Suffolk VA 23434-5255 Ph: (757) 539-5353 |
| NPI Number | 1487090429 |
|---|---|
| Provider Enumeration Date | 05/17/2013 |
| Last Update Date | 05/17/2013 |
| Medicare PECOS PAC ID | 8921242918 |
|---|---|
| Medicare Enrollment ID | O20130912000531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487090429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 09040007534 (Virginia) | Primary |
| Provider Name | Kawanna Evette Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043515331 PECOS PAC ID: 9830333822 Enrollment ID: I20130913000292 |
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