Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0803000056 | VA |
NPI | 1003907130 |
---|---|
Provider Name | Mrs. Sarah C Childress |
First Address | Winchester, VA 22601 |
Second Address | Winchester, VA 22601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077570 | ANTHEM BCBS (01) | VA |
088749 | COMMUNITY HEALTH (01) | VA |