Provider Demographics
NPI:1962432294
Name:CATHOLIC CHARITIES OF EASTERN VIRGINIA INC
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF EASTERN VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CALGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-456-2366
Mailing Address - Street 1:5361A VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1897
Mailing Address - Country:US
Mailing Address - Phone:757-456-2366
Mailing Address - Fax:757-456-2367
Practice Address - Street 1:4855 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4446
Practice Address - Country:US
Practice Address - Phone:757-467-7707
Practice Address - Fax:757-495-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherANTHEM BLUE CROSS BLUE SH
VA=========OtherTRICARE
VA=========OtherSENTARA-OPTIMA-OPTIMA FC
VA=========OtherVIRGINIA PREMIER
VA=========OtherCOMPSYCH
VA=========Medicaid