Provider Demographics
NPI:1033262191
Name:FOR CHILDREN'S SAKE EMERGENCY DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:FOR CHILDREN'S SAKE EMERGENCY DIAGNOSTIC CENTER
Other - Org Name:FOR CHILDREN'S SAKE OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-817-9890
Mailing Address - Street 1:4805 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5733
Mailing Address - Country:US
Mailing Address - Phone:703-583-6971
Mailing Address - Fax:703-583-6975
Practice Address - Street 1:4805 WELLESLEY DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5733
Practice Address - Country:US
Practice Address - Phone:703-583-6971
Practice Address - Fax:703-583-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA58614001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children