Provider Demographics
NPI:1245499722
Name:CHERYL KABANA-ROSS, PC
Entity type:Organization
Organization Name:CHERYL KABANA-ROSS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KABANA-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-594-9701
Mailing Address - Street 1:753 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3564
Mailing Address - Country:US
Mailing Address - Phone:757-594-9701
Mailing Address - Fax:757-594-9830
Practice Address - Street 1:753 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3564
Practice Address - Country:US
Practice Address - Phone:757-594-9701
Practice Address - Fax:757-594-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA083677OtherOPTIMA
VA155745OtherVALUE OPTIONS
VA8927090Medicaid
VA285860OtherANTHEM BLUE CROSS BLUE SHIELD
VA8927090Medicaid