MEDICARE: CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538364179	OTHER	VA	MARY A BRANTLEY - PROVIDER
2	1295888501	OTHER	VA	KRISTIN HARDEE-POULIN - PROVIDER
3	1689689234	OTHER	VA	FREDRICK D WESTON - PROVIDER
4	1285737205	OTHER	VA	GLORIA M SAUNDERS - PROVIDER
5	1417028291	OTHER	VA	CONSTANTINA KOUZI
6	1215917315	OTHER	VA	JAMES ZELL - PROVIDER
7	1033273560	OTHER	VA	J. KELLIE EVANS - PROVIDER
8	1194891598	OTHER	VA	ANDREA LONG - PROVIDER
9	1487764825	OTHER	VA	DEBORAH LEECY - PROVIDER
10	1487840641	OTHER	VA	SHAWN WARE-AVANT - PROVIDER

NPI Number	:	1629158159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC

Provider Business Mailing Address
First Line	:	222 W 19TH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2218
Country	:	US
Telephone Number	:	757-622-7017
Fax Number	:	757-640-8402

Provider Business Practice Location Address
First Line	:	222 W 19TH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2218
Country	:	US
Telephone Number	:	757-622-7017
Fax Number	:	757-640-8402

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MS. BRENDA LUVERNE JONES
Credential	:
Telephone Number	:	757-622-7017

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/19/2012