Provider Demographics
NPI:1124309992
Name:FORD, CHAMIA
Entity type:Individual
Prefix:
First Name:CHAMIA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 THREECHOPT RD
Mailing Address - Street 2:301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-562-9996
Mailing Address - Fax:804-562-9742
Practice Address - Street 1:8716 LANDMARK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2802
Practice Address - Country:US
Practice Address - Phone:804-562-9997
Practice Address - Fax:804-562-9742
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid