Provider Demographics
NPI:1154496966
Name:CITY OF CHESAPEAKE TA CHESAPEAKE COMMUNITY SERV BOARD
Entity Type:Organization
Organization Name:CITY OF CHESAPEAKE TA CHESAPEAKE COMMUNITY SERV BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANLANDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA CPA
Authorized Official - Phone:757-547-9334
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:224 GREAT BRIDGE BLVD CHESAPEAKE COMM SERVICES BOARD
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-547-9334
Mailing Address - Fax:757-819-6292
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:CHESAPEAKE COMM SERVICES BOARD
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001880101Y00000X
VA0904003047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA143683OtherTRIGON ANTHEM
VA083109OtherOPTIMA SENTARA