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500 E Main St Ste 1600 Norfolk VA 23510-2206 | |
| (757) 737-3560 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 500 E Main St Ste 1600, Norfolk, Virginia |
| Authorized Official Name and Position | Villey Tidwell (OWNER) |
| Authorized Official Contact | 7577373560 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 E Main St Ste 1600 Norfolk VA 23510-2206 Ph: (757) 737-3560 | 500 E Main St Ste 1600 Norfolk VA 23510-2206 Ph: (757) 737-3560 |
| NPI Number | 1891506390 |
|---|---|
| Provider Enumeration Date | 01/15/2025 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891506390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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