Provider Demographics
NPI:1902988702
Name:CLEARR VISSION SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:CLEARR VISSION SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERWIN
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-527-0992
Mailing Address - Street 1:7818 CAMOLIN CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-6400
Mailing Address - Country:US
Mailing Address - Phone:804-527-0992
Mailing Address - Fax:804-271-8612
Practice Address - Street 1:5812 NORTHFORD PL
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7590
Practice Address - Country:US
Practice Address - Phone:804-271-7263
Practice Address - Fax:804-271-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities