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General NPI Number Information
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NPI Number | 1639281231
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Entity Type | Organization
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Legal Business Name | FOR CHILDREN'S SAKE OF VIRGINIA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 14900 BOGLE DR SUITE 200
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City | CHANTILLY
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State | VA
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Zip | 20151-1756
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Country | US
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Telephone | 703-817-9890
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Fax | 703-817-9860
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Provider Business Mailing Address
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Address Line | 14900 BOGLE DR SUITE 200
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City | CHANTILLY
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State | VA
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Zip | 20151-1756
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Country | US
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Telephone | 703-817-9890
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Fax | 703-817-9860
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Authorized Official
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Title or Position | CEO
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Name | DEBORAH K EVANS
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Credential | LCSW, BCD
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 904002080
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006815
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007372
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904008453
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003512
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License Number State | VA
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