Provider Demographics
NPI:1467949024
Name:CHILDREN'S HEALTH ASSOCIATES OF TIDEWATER
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH ASSOCIATES OF TIDEWATER
Other - Org Name:CHAT BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEJURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-436-2300
Mailing Address - Street 1:513 BAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3824
Mailing Address - Country:US
Mailing Address - Phone:757-436-2300
Mailing Address - Fax:
Practice Address - Street 1:513 BAYLOR CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3824
Practice Address - Country:US
Practice Address - Phone:757-436-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty