| T A Larkspur Psychotheraphy Center | |
|
505 S Independence Blvd Suite 207 Virginia Beach VA 23452-1150 | |
| (757) 497-4965 | |
| (757) 497-4197 |
| Full Name | T A Larkspur Psychotheraphy Center |
|---|---|
| Speciality | Social Worker |
| Location | 505 S Independence Blvd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Mary Ann Bailey Henry (OWNER) |
| Authorized Official Contact | 7574974965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| T A Larkspur Psychotheraphy Center 505 S Independence Blvd Suite 207 Virginia Beach VA 23452-1150 Ph: (757) 497-4965 | T A Larkspur Psychotheraphy Center 505 S Independence Blvd Suite 207 Virginia Beach VA 23452-1150 Ph: (757) 497-4965 |
| NPI Number | 1093855892 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 01/25/2008 |
| Medicare PECOS PAC ID | 6103956180 |
|---|---|
| Medicare Enrollment ID | O20100618000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093855892 | NPI | - | NPPES |
| A000899 | Other | VALUE OPTIONS | |
| 344120 | Other | TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904003282 (Virginia) | Primary |
| Provider Name | Mary Ann Bailey Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801997507 PECOS PAC ID: 5092845073 Enrollment ID: I20100618000074 |
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