1770278764 NPI number — WRITERS' BLOQ THERAPEUTIC SOLUTIONS, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770278764 NPI number — WRITERS' BLOQ THERAPEUTIC SOLUTIONS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRITERS' BLOQ THERAPEUTIC SOLUTIONS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770278764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 COLISEUM XING # 5395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-5971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-455-7283
Provider Business Mailing Address Fax Number:
804-460-6827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 EAST CLAIBORNE STREET
Provider Second Line Business Practice Location Address:
SUITE 334
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-455-7283
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
JAVAIL
Authorized Official Title or Position:
SEX THERAPIST
Authorized Official Telephone Number:
804-455-7283

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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