Provider Demographics
NPI:1285774612
Name:FAMILY APRESERVATION SERVICES, INC.
Entity type:Organization
Organization Name:FAMILY APRESERVATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PENINSULA REGIONAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCP
Authorized Official - Phone:757-838-8520
Mailing Address - Street 1:205 LAKE TOWER DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-838-8520
Mailing Address - Fax:757-838-8528
Practice Address - Street 1:205 LAKE TOWER DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-838-8520
Practice Address - Fax:757-838-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003464251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
O82331MOtherSENTARA-OPTIMA
VA383406OtherTRICARE & MHN
177812OtherANTHEM