Provider Demographics
NPI:1295284255
Name:SEASIDE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SEASIDE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:757-648-8605
Mailing Address - Street 1:1072 LASKIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6387
Mailing Address - Country:US
Mailing Address - Phone:757-648-8605
Mailing Address - Fax:757-648-1363
Practice Address - Street 1:1072 LASKIN RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6387
Practice Address - Country:US
Practice Address - Phone:757-648-8605
Practice Address - Fax:757-648-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty