Healthcare Provider Details

I. General information

NPI: 1740427418
Provider Name (Legal Business Name): CHESAPEAKE COMMUNITY SERVICES BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREAT BRIDGE BLVD
CHESAPEAKE VA
23320-3904
US

IV. Provider business mailing address

224 GREAT BRIDGE BLVD
CHESAPEAKE VA
23320-3904
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9334
  • Fax:
Mailing address:
  • Phone: 757-547-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004407
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001184
License Number StateVA

VIII. Authorized Official

Name: TAMARA THIVIERGE
Title or Position: REIMBURSEMENT SUPERVISOR
Credential:
Phone: 757-819-6219