=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417582800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE CLINICAL & PROFESSIONAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2020
-----------------------------------------------------
Last Update Date | 05/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 WEDGEWOOD DR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-788-1450
-----------------------------------------------------
Fax | 757-210-6571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 WEDGEWOOD DR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-788-1450
-----------------------------------------------------
Fax | 757-257-4143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MS. SHAWNDRA UMBARGER
-----------------------------------------------------
Credential | MA NCC CCMHC
-----------------------------------------------------
Telephone | 757-788-1450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------