Healthcare Provider Details

I. General information

NPI: 1235596065
Provider Name (Legal Business Name): COMMUNITY CHEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EAST CARSON STREET SUITE A
VIRGINIA CITY NV
89440
US

IV. Provider business mailing address

PO BOX 980 175 EAST CARSON STREET
VIRGINIA CITY NV
89440
US

V. Phone/Fax

Practice location:
  • Phone: 775-847-0414
  • Fax: 775-847-9335
Mailing address:
  • Phone: 775-847-0414
  • Fax: 775-848-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV19911013020
License Number StateNV

VIII. Authorized Official

Name: MS. ADRIENNE PATRICIA SUTHERLAND
Title or Position: CLINICAL DIRECTOR/THERAPIST
Credential: MA, LCPC, LCADC
Phone: 775-847-0414