Healthcare Provider Details

I. General information

NPI: 1639281231
Provider Name (Legal Business Name): FOR CHILDREN'S SAKE OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 BOGLE DR SUITE 200
CHANTILLY VA
20151-1756
US

IV. Provider business mailing address

14900 BOGLE DR SUITE 200
CHANTILLY VA
20151-1756
US

V. Phone/Fax

Practice location:
  • Phone: 703-817-9890
  • Fax: 703-817-9860
Mailing address:
  • Phone: 703-817-9890
  • Fax: 703-817-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number904002080
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006815
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007372
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904008453
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003512
License Number StateVA

VIII. Authorized Official

Name: DEBORAH K EVANS
Title or Position: CEO
Credential: LCSW, BCD
Phone: 703-817-9890