Provider Demographics
NPI:1740774322
Name:OMNI PSYCHOTHERAPY
Entity Type:Organization
Organization Name:OMNI PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SENTORIA
Authorized Official - Middle Name:HOWELL
Authorized Official - Last Name:HAROLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-752-5743
Mailing Address - Street 1:920 VENTURES WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2883
Mailing Address - Country:US
Mailing Address - Phone:757-752-5743
Mailing Address - Fax:757-550-3977
Practice Address - Street 1:920 VENTURES WAY STE 4
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2883
Practice Address - Country:US
Practice Address - Phone:757-752-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904104681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty