Provider Demographics
NPI:1841779477
Name:TEACHABLE MOMENTS THERAPY GROUP
Entity Type:Organization
Organization Name:TEACHABLE MOMENTS THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:TIARA
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-535-9080
Mailing Address - Street 1:2019 CUNNINGHAM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3316
Mailing Address - Country:US
Mailing Address - Phone:757-202-8090
Mailing Address - Fax:757-251-6467
Practice Address - Street 1:2019 CUNNINGHAM DR STE 101
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3316
Practice Address - Country:US
Practice Address - Phone:757-535-9080
Practice Address - Fax:757-251-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty