Provider Demographics
NPI:1629158159
Name:CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC
Entity Type:Organization
Organization Name:CHILD & FAMILY SERVICES OF EASTERN VIRGINIA, INC
Other - Org Name:THE UP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LUVERNE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-622-7017
Mailing Address - Street 1:222 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2218
Mailing Address - Country:US
Mailing Address - Phone:757-622-7017
Mailing Address - Fax:757-640-8402
Practice Address - Street 1:222 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2218
Practice Address - Country:US
Practice Address - Phone:757-622-7017
Practice Address - Fax:757-640-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538364179OtherMARY A BRANTLEY - PROVIDER
VA1295888501OtherKRISTIN HARDEE-POULIN - PROVIDER
VA1689689234OtherFREDRICK D WESTON - PROVIDER
VA1285737205OtherGLORIA M SAUNDERS - PROVIDER
VA1417028291OtherCONSTANTINA KOUZI
VA1215917315OtherJAMES ZELL - PROVIDER
VA1033273560OtherJ. KELLIE EVANS - PROVIDER
VA1194891598OtherANDREA LONG - PROVIDER
VA1487764825OtherDEBORAH LEECY - PROVIDER
VA1487840641OtherSHAWN WARE-AVANT - PROVIDER
VA1689689234OtherFREDRICK D WESTON - PROVIDER
VA1538364179OtherMARY A BRANTLEY - PROVIDER
VA1487840641OtherSHAWN WARE-AVANT - PROVIDER