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General NPI Number Information
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NPI Number | 1962748830
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Entity Type | Organization
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Legal Business Name | COMMUNITY S.H.A.R.E., LLC
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Dates
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Enumeration Date | 12/21/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 762 INDEPENDENCE BLVD STE 100C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6250
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Country | US
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Telephone | 757-644-4192
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Fax | 757-644-4196
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Provider Business Mailing Address
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Address Line | 1920 CENTERVILLE TPKE # 117-247
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAYSON JOHNSON
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Credential |
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Telephone | 757-644-4192
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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 | 1807
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License Number State | VA
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