Provider Demographics
NPI:1831482736
Name:BLEIL, MARK THOMAS (LCSW,CSOTP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:BLEIL
Suffix:
Gender:M
Credentials:LCSW,CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 CORPORATE WOODS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4376
Mailing Address - Country:US
Mailing Address - Phone:757-473-3770
Mailing Address - Fax:757-473-3768
Practice Address - Street 1:5029 CORPORATE WOODS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4376
Practice Address - Country:US
Practice Address - Phone:757-473-3770
Practice Address - Fax:757-473-3768
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical