Provider Demographics
NPI:1972783892
Name:CHAMPION, VIRSHAWN M (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRSHAWN
Middle Name:M
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 S MCDOUGAL ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4675
Mailing Address - Country:US
Mailing Address - Phone:812-327-7409
Mailing Address - Fax:
Practice Address - Street 1:315 W DODDS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2510
Practice Address - Country:US
Practice Address - Phone:812-335-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005436A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical