Provider Demographics
NPI:1770677288
Name:MICHAEL S. WEISSMAN, PH.D.,LTD
Entity Type:Organization
Organization Name:MICHAEL S. WEISSMAN, PH.D.,LTD
Other - Org Name:CHURCHLAND PSYCHOLOGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-483-3404
Mailing Address - Street 1:3210 CHURCHLAND BLVD.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321
Mailing Address - Country:US
Mailing Address - Phone:757-483-3404
Mailing Address - Fax:757-483-0461
Practice Address - Street 1:3210 CHURCHLAND BLVD.
Practice Address - Street 2:SUITE 4
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321
Practice Address - Country:US
Practice Address - Phone:757-483-3404
Practice Address - Fax:757-483-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty