Organization
DISTRICT 19 COMMUNITY SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA A NEWBY (EXECUTIVE ASSISTANT)
(804) 862-6082
Entity
Organization
Contact information
Practice address
20 W BANK ST STE 5, PETERSBURG, VA 23803-3279
(804) 862-6082
(804) 862-6158
Mailing address
20 W BANK ST STE 7, PETERSBURG, VA 23803-3279
(804) 862-6082
(804) 862-6158
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
184
VA
Other
Enumeration date
01/25/2018
Last updated
01/25/2018
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