Provider Demographics
NPI:1326482779
Name:BEACH THERAPY & CONSULTING PLLC
Entity Type:Organization
Organization Name:BEACH THERAPY & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOONE-SAVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-912-6214
Mailing Address - Street 1:3419 VIRGINIA BEACH BLVD # 800
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4419
Mailing Address - Country:US
Mailing Address - Phone:757-714-1838
Mailing Address - Fax:757-321-6269
Practice Address - Street 1:228 N LYNNHAVEN RD STE 110
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7514
Practice Address - Country:US
Practice Address - Phone:757-912-6214
Practice Address - Fax:757-321-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)