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General NPI Number Information
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NPI Number | 1295211316
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE SERVICES, LLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1545 CROSSWAYS BLVD STE 250
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0218
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Country | US
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Telephone | 757-309-1405
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 CROSSWAYS BLVD STE 250
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0218
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Country | US
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Telephone | 757-309-1405
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Fax | 757-514-8642
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Authorized Official
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Title or Position | LPC
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Name | ANNIE J SCOTT
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Credential |
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Telephone | 757-309-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2356
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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