Organization
COMMUNITY S.H.A.R.E., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYSON JOHNSON (EXECUTIVE DIRECTOR)
(757) 644-4192
Entity
Organization
Contact information
Practice address
762 INDEPENDENCE BLVD STE 100C, VIRGINIA BEACH, VA 23455-6250
(757) 644-4192
(757) 644-4196
Mailing address
1920 CENTERVILLE TPKE # 117-247, VIRGINIA BEACH, VA 23464-6800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1807
VA
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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