Provider Demographics
NPI:1811139918
Name:NEWSOME, DOUGLAS J (LPC, LSATP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3300
Mailing Address - Country:US
Mailing Address - Phone:757-663-7510
Mailing Address - Fax:757-533-9634
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-663-7510
Practice Address - Fax:757-533-9634
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000051101YA0400X
101YM0800X
VA0701002816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health