Provider Demographics
NPI:1437349875
Name:CHENEY, KIMBERLY PATRICE (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICE
Last Name:CHENEY
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 WASHINGTON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4327
Mailing Address - Country:US
Mailing Address - Phone:757-245-0217
Mailing Address - Fax:757-245-4918
Practice Address - Street 1:600 MEDICAL DR
Practice Address - Street 2:SUITE A-B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1769
Practice Address - Country:US
Practice Address - Phone:757-788-0600
Practice Address - Fax:757-788-0932
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03714OtherMEDICARE
VA49-45573Medicaid