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General NPI Number Information
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NPI Number | 1386067445
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Entity Type | Organization
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Legal Business Name | BETHANY CHRISTIAN SERVICES
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 287 INDEPENDENCE BLVD STE 241
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2956
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Country | US
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Telephone | 757-499-9367
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Fax | 757-518-8356
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Provider Business Mailing Address
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Address Line | 287 INDEPENDENCE BLVD STE 241
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2956
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Country | US
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Telephone | 757-499-9367
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Fax | 757-518-8356
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Authorized Official
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Title or Position | DIRECTOR
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Name | ASHLEY CONRAD
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Credential |
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Telephone | 757-499-9367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0904008280
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License Number State | VA
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