Provider Demographics
NPI:1386775401
Name:CHRYSALIS COUNSELING CENTERS
Entity type:Organization
Organization Name:CHRYSALIS COUNSELING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:540-727-0770
Mailing Address - Street 1:1100 SUNSET LN
Mailing Address - Street 2:SUITE 1310A
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3378
Mailing Address - Country:US
Mailing Address - Phone:540-727-0770
Mailing Address - Fax:540-727-7310
Practice Address - Street 1:1100 SUNSET LN
Practice Address - Street 2:SUITE 1310A
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3378
Practice Address - Country:US
Practice Address - Phone:540-727-0770
Practice Address - Fax:540-727-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040022021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA176567OtherANTHEM RESTON
VA25740018OtherCAREFIRST
VA290799OtherANTHEM RESTON
VA141557OtherANTHEM GAINESVILLE
VA25740016OtherCAREFIRST
VA176568OtherANTHEM RESTON
VA180939OtherANTHEM RESTON
VA176565OtherANTHEM RESTON
VA180938OtherANTHEM GAINESVILLE
VA25740017OtherCAREFIRST
VA115052OtherANTHEM RESTON
VA141107OtherANTHEM GAINESVILLE
VA244776OtherANTHEM GAINESVILLE
VA115049OtherANTHEM GAINESVILLE
VA115774OtherANTHEM CULPEPER
VA172752OtherANTHEM CULPEPER
VA192688OtherANTHEM RESTON
VA192690OtherANTHEM GAINESVILLE
VA290799OtherANTHEM RESTON
VA=========OtherPHCS