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General NPI Number Information
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NPI Number | 1033262191
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Entity Type | Organization
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Legal Business Name | FOR CHILDREN'S SAKE EMERGENCY DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 4805 WELLESLEY DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5733
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Country | US
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Telephone | 703-583-6971
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Fax | 703-583-6975
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Provider Business Mailing Address
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Address Line | 4805 WELLESLEY DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5733
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Country | US
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Telephone | 703-583-6971
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Fax | 703-583-6975
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. DEBORAH K EVANS
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Credential | LCSW
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Telephone | 703-817-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 58614001
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License Number State | VA
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