Provider Demographics
NPI:1164635132
Name:FAMILY PRESERVATION SERVICES
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEED
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:757-838-8520
Mailing Address - Street 1:205 LAKETOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-838-8520
Mailing Address - Fax:757-838-8528
Practice Address - Street 1:205 LAKETOWER DR.
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-838-8520
Practice Address - Fax:757-838-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003898101YP2500X
VA0717001103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO802678MOtherOPTIMA
VA294478OtherBLUE CROSS BLUE SHIELD
VA383405OtherTRICARE