Healthcare Provider Details

I. General information

NPI: 1295211316
Provider Name (Legal Business Name): SOUTHSIDE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

IV. Provider business mailing address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

V. Phone/Fax

Practice location:
  • Phone: 757-309-1405
  • Fax:
Mailing address:
  • Phone: 757-309-1405
  • Fax: 757-514-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2356
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNIE J SCOTT
Title or Position: LPC
Credential:
Phone: 757-309-1405