Provider Demographics
NPI:1053868232
Name:EAST COAST FAMILY SERVICES
Entity Type:Organization
Organization Name:EAST COAST FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAR
Authorized Official - Middle Name:LEVELL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-535-8654
Mailing Address - Street 1:999 WATERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-3300
Mailing Address - Country:US
Mailing Address - Phone:757-535-8654
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR
Practice Address - Street 2:SUITE 2525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3300
Practice Address - Country:US
Practice Address - Phone:757-535-8654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2405251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health