Healthcare Provider Details

I. General information

NPI: 1588956395
Provider Name (Legal Business Name): HAMPTON ROADS FAMILY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 INDIAN RIVER RD STE 3
CHESAPEAKE VA
23325-3100
US

IV. Provider business mailing address

4310 INDIAN RIVER RD STE 3
CHESAPEAKE VA
23325-3100
US

V. Phone/Fax

Practice location:
  • Phone: 757-737-3050
  • Fax: 757-966-5030
Mailing address:
  • Phone: 757-737-3050
  • Fax: 757-966-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTOINETTE NUMITAL THORNTON
Title or Position: PRESIDENT
Credential: MSW, CSAC, CSTOP
Phone: 757-737-3050