Provider Demographics
NPI:1376813410
Name:OYSTER POINT COUNSELING CENTER
Entity Type:Organization
Organization Name:OYSTER POINT COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LATSKO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:757-240-1067
Mailing Address - Street 1:PO BOX 2057
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-240-1067
Mailing Address - Fax:757-659-0128
Practice Address - Street 1:1 OLD OYSTER POINT RD
Practice Address - Street 2:SUITE 250
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7121
Practice Address - Country:US
Practice Address - Phone:757-240-1067
Practice Address - Fax:757-659-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001186106H00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty