Provider Demographics
NPI:1710281803
Name:CITY OF NORFOLK
Entity Type:Organization
Organization Name:CITY OF NORFOLK
Other - Org Name:NORFOLK COMMUNITY SERVICES BOARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, NCSB
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-756-5600
Mailing Address - Street 1:7447 CENTRAL BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2867
Mailing Address - Country:US
Mailing Address - Phone:757-756-5600
Mailing Address - Fax:
Practice Address - Street 1:7447 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2867
Practice Address - Country:US
Practice Address - Phone:757-756-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA241070042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945565Medicaid
VACO1883Medicare Oscar/Certification