Provider Demographics
NPI:1316947328
Name:PSYCHOTHERAPY RESOURCES OF NORFOLK LTD
Entity type:Organization
Organization Name:PSYCHOTHERAPY RESOURCES OF NORFOLK LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:KEDROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-640-0400
Mailing Address - Street 1:1709 COLLEY AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1675
Mailing Address - Country:US
Mailing Address - Phone:757-640-0400
Mailing Address - Fax:757-640-0497
Practice Address - Street 1:1709 COLLEY AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1675
Practice Address - Country:US
Practice Address - Phone:757-640-0400
Practice Address - Fax:757-640-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040002341041C0700X
VA4274101YP2500X, 103TC0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA314544OtherTRICARE
VA098384OtherBCBS
VA049956OtherBCBS
VA049956OtherBCBS