Provider Demographics
NPI:1902818990
Name:PATRICK COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:PATRICK COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:SW
Authorized Official - Phone:276-694-3328
Mailing Address - Street 1:106 RUCKER ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1619
Mailing Address - Country:US
Mailing Address - Phone:276-694-3328
Mailing Address - Fax:276-694-8210
Practice Address - Street 1:106 RUCKER ST
Practice Address - Street 2:SUITE 128
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1619
Practice Address - Country:US
Practice Address - Phone:276-694-3328
Practice Address - Fax:276-694-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8741239Medicaid