Organization
GIRLS IN RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAZ LAMAR CLYBURN APC (FOUNDER AND CEO)
(757) 892-0847
Entity
Organization
Contact information
Practice address
2920 N ARMISTEAD AVE, HAMPTON, VA 23666-1640
(757) 798-9094
Mailing address
5321 JUSTIN CT APT 101, VIRGINIA BEACH, VA 23462-1352
(757) 892-0847
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A61620350
VIRGINIA ID CARD
VA
Enumeration date
05/20/2021
Last updated
06/15/2021
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