Provider Demographics
NPI:1306509252
Name:FOCUSED GROWTH PSYCHOTHERAPY
Entity type:Organization
Organization Name:FOCUSED GROWTH PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, MBR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-702-0119
Mailing Address - Street 1:3419 VIRGINIA BEACH BLVD
Mailing Address - Street 2:#133
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4419
Mailing Address - Country:US
Mailing Address - Phone:757-702-0119
Mailing Address - Fax:757-702-0119
Practice Address - Street 1:2509 BUTLER LANE
Practice Address - Street 2:#133
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4419
Practice Address - Country:US
Practice Address - Phone:757-702-0119
Practice Address - Fax:757-702-0119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOCUSED GROWTH PSYCHOTHERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty