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General NPI Number Information
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NPI Number | 1497360465
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Entity Type | Organization
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Legal Business Name | CONQUERING OBSTACLES WITH AMBITIOUS COMMITMENT & HEALING, LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 08/07/2021
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Provider Practice Location Address
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Address Line | 2005 OLD GREENBRIER RD STE 102
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2649
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Country | US
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Telephone | 757-550-1594
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Fax | 757-578-8244
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Provider Business Mailing Address
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Address Line | 1216 GRANBY ST STE 206
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City | NORFOLK
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State | VA
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Zip | 23510-2622
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Country | US
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Telephone | 757-550-1594
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Fax | 757-578-8244
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | MRS. SHANA SIMMONS
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Credential | LCSW
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Telephone | 757-701-0762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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