Basic Information
| Provider Information | |||||||||
| NPI: | 1679915052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOUTHWELL | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | BOJARSKI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 GUM ROCK CT | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236062523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732273 | ||||||||
| FaxNumber: | 7578739422 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 GUM ROCK CT | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236062523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732273 | ||||||||
| FaxNumber: | 7578739422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2013 | ||||||||
| LastUpdateDate: | 05/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C009786 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904009837 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.