Provider Demographics
NPI:1033222518
Name:CHUCKER, INGRID KIMBERLEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:KIMBERLEE
Last Name:CHUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6477 COLLEGE PARK SQ
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:757-424-0100
Mailing Address - Fax:757-424-5623
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:SUITE 302
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-424-0100
Practice Address - Fax:757-424-5623
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8914729Medicaid
VAR61348Medicare UPIN