Provider Demographics
NPI:1558592410
Name:CHILDREY, AVE SIMONE (MSW)
Entity Type:Individual
Prefix:MS
First Name:AVE
Middle Name:SIMONE
Last Name:CHILDREY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2103
Mailing Address - Country:US
Mailing Address - Phone:410-676-4233
Mailing Address - Fax:
Practice Address - Street 1:BLDG 11H AVENUE D
Practice Address - Street 2:VAMHCS MEDICAL CENTER
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker