Provider Demographics
NPI:1710731005
Name:DOMINION COMMUNITY INTEGRATION SERVICES INC.
Entity Type:Organization
Organization Name:DOMINION COMMUNITY INTEGRATION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEKU
Authorized Official - Middle Name:BRIMA STEWART
Authorized Official - Last Name:LAHAI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-953-9317
Mailing Address - Street 1:4349 RIDGEWOOD CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8330
Mailing Address - Country:US
Mailing Address - Phone:703-953-9317
Mailing Address - Fax:
Practice Address - Street 1:4349 RIDGEWOOD CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8330
Practice Address - Country:US
Practice Address - Phone:703-953-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9013OtherDBHDS CENTER-BASED DAY SUPPORT ADULT