Provider Demographics
NPI:1356035000
Name:PRINCE PSYCHOTHERAPY
Entity type:Organization
Organization Name:PRINCE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-306-4232
Mailing Address - Street 1:512 S LYNNHAVEN ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6664
Mailing Address - Country:US
Mailing Address - Phone:757-306-4232
Mailing Address - Fax:757-306-4235
Practice Address - Street 1:512 S LYNNHAVEN ROAD
Practice Address - Street 2:STE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6664
Practice Address - Country:US
Practice Address - Phone:757-306-4232
Practice Address - Fax:757-306-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty