Provider Demographics
| NPI: | 1720551963 |
|---|---|
| Name: | WHITE CLOUD THERAPEUTIC SERVICES, LLC |
| Entity type: | Organization |
| Organization Name: | WHITE CLOUD THERAPEUTIC SERVICES, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CLINICAL PSYCHOLOGIST/OWNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | JOSEPH |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | GARCIA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PSYD |
| Authorized Official - Phone: | 757-503-7917 |
| Mailing Address - Street 1: | 324 MONTICELLO AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WILLIAMSBURG |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 23185-2834 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 757-503-7917 |
| Mailing Address - Fax: | 855-823-3243 |
| Practice Address - Street 1: | 324 MONTICELLO AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | WILLIAMSBURG |
| Practice Address - State: | VA |
| Practice Address - Zip Code: | 23185-2834 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 757-503-7917 |
| Practice Address - Fax: | 855-823-3243 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | WHITE CLOUD THERAPEUTIC SERVICES, LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2019-01-10 |
| Last Update Date: | 2023-04-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VA | 601426497 | Medicaid | |
| VA | 0812081 | Other | OPTIMA |
