Provider Demographics
NPI:1255760997
Name:ABRAHAM, ANNE CHISMAN (LCSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CHISMAN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MM
Other - Last Name:CHISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-489-4700
Mailing Address - Fax:757-489-0240
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 401
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-489-4700
Practice Address - Fax:757-489-0240
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO2798OtherGROUP MEDICARE