Provider Demographics
NPI:1053198507
Name:NIEVES, CHRASANTHUM (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:CHRASANTHUM
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PREFERRED/PROFESSION
Mailing Address - Street 1:PO BOX 9236
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-9236
Mailing Address - Country:US
Mailing Address - Phone:757-994-8702
Mailing Address - Fax:
Practice Address - Street 1:4208 JENNELL CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1913
Practice Address - Country:US
Practice Address - Phone:757-994-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLACS-28580101YA0400X
VA09040167231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)