Provider Demographics
NPI:1679185573
Name:SHAPING YOUR FUTURE PSYCHIATRY
Entity Type:Organization
Organization Name:SHAPING YOUR FUTURE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:NARDIA
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-528-2850
Mailing Address - Street 1:5705 LYNNHAVEN PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-9157
Mailing Address - Country:US
Mailing Address - Phone:757-528-2850
Mailing Address - Fax:757-432-3159
Practice Address - Street 1:5705 LYNNHAVEN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-9157
Practice Address - Country:US
Practice Address - Phone:757-528-2850
Practice Address - Fax:757-432-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty