Provider Demographics
NPI:1659386209
Name:KABANA-ROSS, CHERYL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KABANA-ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3564
Mailing Address - Country:US
Mailing Address - Phone:757-594-9701
Mailing Address - Fax:757-594-9830
Practice Address - Street 1:753 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3564
Practice Address - Country:US
Practice Address - Phone:757-594-9701
Practice Address - Fax:757-594-9830
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8927090Medicaid