Provider Demographics
NPI:1124060314
Name:CLINICAL ASSOCIATES OF TIDEWATER, P.C.
Entity type:Organization
Organization Name:CLINICAL ASSOCIATES OF TIDEWATER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-456-0505
Mailing Address - Street 1:6320 N CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4009
Mailing Address - Country:US
Mailing Address - Phone:757-456-0505
Mailing Address - Fax:757-456-0817
Practice Address - Street 1:6320 N CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4009
Practice Address - Country:US
Practice Address - Phone:757-456-0505
Practice Address - Fax:757-456-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8917124Medicaid
VA6717951Medicaid
VA7704241Medicaid
VA7730667Medicaid
VA216460OtherMARK YARHOUSE-ANTHEM
VA72705OtherNANCY PASCHALL-ANTHEM
VA7702451Medicaid
VA7761775Medicaid
VA322713OtherFRANK AIELLO,MD - ANTHEM
VA72702OtherREBECCA REID - ANTHEM
VA93140OtherCAROLYN JOHNSON-ANTHEM
VA800000241Medicare ID - Type UnspecifiedREBECCA D. REID, LCSW
VA6717951Medicaid
VA7730667Medicaid
VA72702OtherREBECCA REID - ANTHEM
VA7704241Medicaid
VA7761775Medicaid
VAR65897Medicare UPIN
VA7702451Medicaid