Provider Demographics
NPI:1891210746
Name:EASTERN SHORE COMMUNITY SERVICES BOARD
Entity Type:Organization
Organization Name:EASTERN SHORE COMMUNITY SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNIEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-442-3636
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:10129 ROGERS DRIVE
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413
Mailing Address - Country:US
Mailing Address - Phone:757-442-3636
Mailing Address - Fax:757-442-2319
Practice Address - Street 1:19056 GREENBUSH ROAD
Practice Address - Street 2:EASTERN SHORE BEHAVIOR HEALTHCARE CENTER
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-9998
Practice Address - Country:US
Practice Address - Phone:757-465-1260
Practice Address - Fax:757-665-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty