Healthcare Provider Details

I. General information

NPI: 1841435286
Provider Name (Legal Business Name): FOR CHILDREN'S SAKE OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 BOGLE DR STE 200
CHANTILLY VA
20151-1756
US

IV. Provider business mailing address

14900 BOGLE DR STE 200
CHANTILLY VA
20151-1756
US

V. Phone/Fax

Practice location:
  • Phone: 703-817-9890
  • Fax: 571-321-0322
Mailing address:
  • Phone: 703-817-9890
  • Fax: 571-321-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DEBORAH EVANS
Title or Position: CEO
Credential: LCSW
Phone: 703-817-9890