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NPI Code Detail

MEDICARE: SOUTHSIDE SERVICES, LLC

MEDICARE: SOUTHSIDE SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2324500000XSubstance Abuse Rehabilitation Facility
3320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility
4251S00000XCommunity/Behavioral Health Agency2356VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295211316
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE SERVICES, LLC
Provider Business Mailing Address
First Line : 1545 CROSSWAYS BLVD STE 250
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-0218
Country : US
Telephone Number : 757-309-1405
Fax Number : 757-514-8642
Provider Business Practice Location Address
First Line : 1545 CROSSWAYS BLVD STE 250
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-0218
Country : US
Telephone Number : 757-309-1405
Fax Number :
Authorized Official
Title or Position : LPC
Name : ANNIE J SCOTT
Credential :
Telephone Number : 757-309-1405
Provider Enumeration Date : 07/11/2018
Last Update Date : 01/21/2026

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Directions to “SOUTHSIDE SERVICES, LLC ” Practice Location

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