Provider Demographics
NPI:1639281231
Name:FOR CHILDREN'S SAKE OF VIRGINIA
Entity Type:Organization
Organization Name:FOR CHILDREN'S SAKE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:703-817-9890
Mailing Address - Street 1:14900 BOGLE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1756
Mailing Address - Country:US
Mailing Address - Phone:703-817-9890
Mailing Address - Fax:703-817-9860
Practice Address - Street 1:14900 BOGLE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1756
Practice Address - Country:US
Practice Address - Phone:703-817-9890
Practice Address - Fax:703-817-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904008453101YM0800X
VA09040035121041C0700X
VA9040020801041C0700X
VA09040068151041C0700X
VA09040073721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639281231Medicaid