Provider Demographics
NPI:1265022354
Name:C&C THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:C&C THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-641-5176
Mailing Address - Street 1:4169 VIRGINIA BEACH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1783
Mailing Address - Country:US
Mailing Address - Phone:804-641-5176
Mailing Address - Fax:757-210-3996
Practice Address - Street 1:4169 VIRGINIA BEACH BLVD STE 150
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1783
Practice Address - Country:US
Practice Address - Phone:804-641-5176
Practice Address - Fax:757-210-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)