Provider Demographics
NPI:1861812026
Name:SEA LEVEL COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:SEA LEVEL COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-937-5780
Mailing Address - Street 1:2200 COLONIAL AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1919
Mailing Address - Country:US
Mailing Address - Phone:757-937-5780
Mailing Address - Fax:757-937-5781
Practice Address - Street 1:2200 COLONIAL AVE STE 12
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1919
Practice Address - Country:US
Practice Address - Phone:757-937-5780
Practice Address - Fax:757-937-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447487483Medicaid