Provider Demographics
NPI:1356394696
Name:HAMPTON ROADS BEHAVIORAL HEALTH,PC
Entity type:Organization
Organization Name:HAMPTON ROADS BEHAVIORAL HEALTH,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-587-4744
Mailing Address - Street 1:1500 E LITTLE CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4137
Mailing Address - Country:US
Mailing Address - Phone:757-587-4744
Mailing Address - Fax:757-587-4947
Practice Address - Street 1:1500 E LITTLE CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:757-587-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03508Medicare ID - Type UnspecifiedGROUP NUMBER