Provider Demographics
NPI:1467832469
Name:CITY OF ALEXANDRIA
Entity Type:Organization
Organization Name:CITY OF ALEXANDRIA
Other - Org Name:ALEXANDRIA CSB PIE PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, CSB
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-746-3461
Mailing Address - Street 1:720 N SAINT ASAPH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 N SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1912
Practice Address - Country:US
Practice Address - Phone:703-746-3461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health