Provider Demographics
NPI:1467805671
Name:EDWARD GUYTON, LCSW
Entity Type:Organization
Organization Name:EDWARD GUYTON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GUYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-286-0264
Mailing Address - Street 1:1341 SURREY CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1130
Mailing Address - Country:US
Mailing Address - Phone:757-286-0264
Mailing Address - Fax:757-440-5655
Practice Address - Street 1:425 W 20TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2128
Practice Address - Country:US
Practice Address - Phone:757-286-0264
Practice Address - Fax:757-440-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006140251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVC6260281OtherMEDICARE PTAN