Provider Demographics
NPI:1407187263
Name:CHILDS, KEVIN STEVEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:STEVEN
Last Name:CHILDS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 BLUE BEECH WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3811
Mailing Address - Country:US
Mailing Address - Phone:757-418-4974
Mailing Address - Fax:757-320-0282
Practice Address - Street 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE 40
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-418-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical