Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tidewater Mobile Medicine, PLLC

Organization Addiction (Substance Use Disorder) Counselor · NPI 1225527351

Tidewater Mobile Medicine, PLLC is an Addiction (Substance Use Disorder) Counselor in Portsmouth, Virginia. Works from 2 locations. Licensed in Virginia.

Licensed in
VA
In the registry since
2018
Specialties on file
5
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3520 High St Ste 100
Portsmouth, VA 23707-3126
Phone: (757) 977-9675
Fax: (757) 483-8099
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3001 Churchland Blvd, Chesapeake, VA 23321-5603 — (757) 977-9675

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X
Clinical Social Worker Taxonomy 1041C0700X
Primary Care Clinic/Center Taxonomy 261QP2300X · Licence 46193 (VA)
Non-emergency Medical Transport (VAN) Taxonomy 343900000X

Record details

NPI number1225527351
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationTidewater Mobile Medicine PLLC
Authorized official Jimmy Cooper — Ceo/Owner · (757) 977-9675
Other names Authentic Self Counseling Services; Tmm Medical Group
NPI enumeratedMay 3, 2018
Last updated in NPPESJanuary 21, 2022
Certification dateJanuary 21, 2022
Mailing address3520 High St Ste 100, Portsmouth, VA 23707-3126

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