Provider Demographics
NPI:1124562244
Name:NORFOLK CRISIS STABILIZATION PROGRAM
Entity Type:Organization
Organization Name:NORFOLK CRISIS STABILIZATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-664-6679
Mailing Address - Street 1:7464 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3845
Mailing Address - Country:US
Mailing Address - Phone:757-664-6679
Mailing Address - Fax:
Practice Address - Street 1:7464 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3845
Practice Address - Country:US
Practice Address - Phone:757-664-6679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORFOLK COMMUNITY SERVICES BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health