1447245543 NPI number — MR. DOUGLAS G. MORIN LCSW

Table of content: MR. DOUGLAS G. MORIN LCSW (NPI 1447245543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447245543 NPI number — MR. DOUGLAS G. MORIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORIN
Provider First Name:
DOUGLAS
Provider Middle Name:
G.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1447245543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1014 PRISCILLA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-803-3325
Provider Business Mailing Address Fax Number:
757-819-6292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5040 VIRGINIA BEACH BLVD. SUITE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-985-4740
Provider Business Practice Location Address Fax Number:
757-819-6292
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904002388 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143678 . This is a "ANTHEM TRIGON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 298610 . This is a "MAMSI UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 043842 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 263116000 . This is a "MAGELLEAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 085586 . This is a "SENTARA/OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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