Provider Demographics
NPI:1386716744
Name:CHILD DEVELOPMENT RESOURCES
Entity type:Organization
Organization Name:CHILD DEVELOPMENT RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:757-566-3300
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:NORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23127-0280
Mailing Address - Country:US
Mailing Address - Phone:757-566-3300
Mailing Address - Fax:757-566-8977
Practice Address - Street 1:150 POINT O WOODS
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7052
Practice Address - Country:US
Practice Address - Phone:757-566-3300
Practice Address - Fax:757-566-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194409OtherANTHEM - PHYSICAL THERAPY
VA4978501Medicaid
VA45084OtherOPTIMA
VA194410OtherANTHEM - OCCUPATIONAL THE
VA194411OtherANTHEM - SPEECH THERAPY
VA194411OtherANTHEM - SPEECH THERAPY