Provider Demographics
NPI:1659424448
Name:HAMPTON NEWPORT NEWS COMMUNITY SERVICES BOARD
Entity type:Organization
Organization Name:HAMPTON NEWPORT NEWS COMMUNITY SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-788-0300
Mailing Address - Street 1:300 MEDICAL DRIVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1765
Mailing Address - Country:US
Mailing Address - Phone:757-788-0300
Mailing Address - Fax:757-788-0969
Practice Address - Street 1:300 MEDICAL DRIVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1765
Practice Address - Country:US
Practice Address - Phone:757-788-0300
Practice Address - Fax:757-788-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X, 261QR0405X
VA019251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945573Medicaid
VA4945573Medicaid